Healthcare Provider Details

I. General information

NPI: 1902650310
Provider Name (Legal Business Name): CYNTHIA WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NE DIXIE HWY STE A4
STUART FL
34994-1882
US

IV. Provider business mailing address

2717 W CYPRESS CREEK RD
FORT LAUDERDALE FL
33309-1703
US

V. Phone/Fax

Practice location:
  • Phone: 772-419-8831
  • Fax: 772-365-3155
Mailing address:
  • Phone: 954-979-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH22683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: