Provider Demographics
NPI:1316346844
Name:WARREN, SALLY (DN PSY)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:DN PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1713
Mailing Address - Country:US
Mailing Address - Phone:831-535-8415
Mailing Address - Fax:
Practice Address - Street 1:644 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1713
Practice Address - Country:US
Practice Address - Phone:831-535-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator