Provider Demographics
NPI:1306946264
Name:WARNER, AMY LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:WARNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:HUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2643 APPIAN WAY STE A1
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2253
Mailing Address - Country:US
Mailing Address - Phone:510-375-3282
Mailing Address - Fax:
Practice Address - Street 1:2643 APPIAN WAY STE A1
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2253
Practice Address - Country:US
Practice Address - Phone:510-375-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS# 222421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA09047Medicaid