Provider Demographics
NPI:1124608658
Name:WARNER, ANNETTE MARLENE (LICSW)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARLENE
Last Name:WARNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 WALDORF RD
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-4036
Mailing Address - Country:US
Mailing Address - Phone:507-383-4778
Mailing Address - Fax:
Practice Address - Street 1:1814 WALDORF RD
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-4036
Practice Address - Country:US
Practice Address - Phone:507-383-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN162021041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool