Healthcare Provider Details

I. General information

NPI: 1265164008
Provider Name (Legal Business Name): TIMARRA MARIE WARREN PMHNP-DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST FL 14
BOSTON MA
02114-2509
US

IV. Provider business mailing address

100 CAMBRIDGE ST FL 14
BOSTON MA
02114-2509
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax:
Mailing address:
  • Phone: 646-941-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2307292
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2307292
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN311096
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN2307292
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2307292
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: