Provider Demographics
NPI:1588148498
Name:PANKEY-WARREN, ELIZABETH ANN (LCSW, M DIV)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:PANKEY-WARREN
Suffix:
Gender:F
Credentials:LCSW, M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 CHERRY PALM RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7988
Mailing Address - Country:US
Mailing Address - Phone:561-866-6607
Mailing Address - Fax:561-338-1752
Practice Address - Street 1:2250 CHERRY PALM RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-7988
Practice Address - Country:US
Practice Address - Phone:561-866-6607
Practice Address - Fax:561-338-1752
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW150741041C0700X
FL150741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical