Provider Demographics
NPI:1336264092
Name:WARNS, JEANINE MARIE (LCSW,CASAC)
Entity type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:MARIE
Last Name:WARNS
Suffix:
Gender:F
Credentials:LCSW,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13235 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952
Mailing Address - Country:US
Mailing Address - Phone:631-965-7750
Mailing Address - Fax:631-298-4344
Practice Address - Street 1:13235 MAIN RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952
Practice Address - Country:US
Practice Address - Phone:631-965-7750
Practice Address - Fax:631-298-4344
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077132-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical