Provider Demographics
NPI:1316079064
Name:LUDWIG, WARREN W (PHD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:W
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SWINBURNE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1834
Mailing Address - Country:US
Mailing Address - Phone:919-212-8447
Mailing Address - Fax:919-250-3943
Practice Address - Street 1:220 SWINBURNE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1834
Practice Address - Country:US
Practice Address - Phone:919-212-8447
Practice Address - Fax:919-250-3943
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1166103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000741Medicaid
NC6000741Medicaid