Provider Demographics
NPI:1427127182
Name:WARNOCK, GLENN
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:WARNOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6033
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-6033
Mailing Address - Country:US
Mailing Address - Phone:845-532-7014
Mailing Address - Fax:845-334-5301
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:UCMH
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6441
Practice Address - Country:US
Practice Address - Phone:845-334-5335
Practice Address - Fax:845-334-5301
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)