Healthcare Provider Details

I. General information

NPI: 1174757488
Provider Name (Legal Business Name): PAMELA WARREN PH.D., LCSW, LISW, M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N. MADISON RD.
ORANGE VA
22960
US

IV. Provider business mailing address

311 N. MADISON RD.
ORANGE VA
22960
US

V. Phone/Fax

Practice location:
  • Phone: 540-661-3465
  • Fax: 540-672-1196
Mailing address:
  • Phone: 540-661-3465
  • Fax: 540-829-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI000832
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007156
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: