Healthcare Provider Details

I. General information

NPI: 1437249455
Provider Name (Legal Business Name): JACQUELINE MARIA WARREN LCSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TILLEY PL
SEA CLIFF NY
11579-1019
US

IV. Provider business mailing address

245 TILLEY PL
SEA CLIFF NY
11579-1019
US

V. Phone/Fax

Practice location:
  • Phone: 516-801-0703
  • Fax: 516-801-0703
Mailing address:
  • Phone: 516-801-0703
  • Fax: 516-801-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5263
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR053561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: