Healthcare Provider Details

I. General information

NPI: 1205872892
Provider Name (Legal Business Name): MARY HEARN WARREN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH HEARN

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 N UNIVERSITY DR SUITE 4
DAVIE FL
33024-9000
US

IV. Provider business mailing address

3349 N UNIVERSITY DR SUITE 4
DAVIE FL
33024-9000
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-9500
  • Fax:
Mailing address:
  • Phone: 954-885-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 5568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: