Healthcare Provider Details

I. General information

NPI: 1992183453
Provider Name (Legal Business Name): JENNY L. WARNE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9846 LORI RD SUITE 201
CHESTERFIELD VA
23832-6695
US

IV. Provider business mailing address

9846 LORI RD SUITE 201
CHESTERFIELD VA
23832-6695
US

V. Phone/Fax

Practice location:
  • Phone: 804-419-4122
  • Fax:
Mailing address:
  • Phone: 804-419-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: