Healthcare Provider Details

I. General information

NPI: 1215768692
Provider Name (Legal Business Name): EILEEN WARREN, PHD PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 RAILROAD ST
PASO ROBLES CA
93446-2532
US

IV. Provider business mailing address

132 VIA FUCHSIA
PASO ROBLES CA
93446-1873
US

V. Phone/Fax

Practice location:
  • Phone: 805-712-5528
  • Fax:
Mailing address:
  • Phone: 805-712-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EILEEN WARREN
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 805-712-5528