MEDICARE: WARREN PSYCHIATRIC SERVICES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52778Z	OTHER		BC/BS
2	Z5740Z	OTHER		BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1083784318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARREN PSYCHIATRIC SERVICES PA

Provider Business Mailing Address
First Line	:	516 LAKEVIEW ROAD
Second Line	:	VILLA 9
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3302
Country	:	US
Telephone Number	:	727-298-8338
Fax Number	:	727-298-0381

Provider Business Practice Location Address
First Line	:	516 LAKEVIEW ROAD
Second Line	:	VILLA 9
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3302
Country	:	US
Telephone Number	:	727-298-8338
Fax Number	:	727-298-0381

Authorized Official
Title or Position	:	SECRETARY FOR PA
Name	:	MS. CAROL K MILLER
Credential	:	LCSW
Telephone Number	:	727-298-8338

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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