=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053467522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUDITH L. WARREN, PH.D., P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 WESTERN AVE SUITE 310
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98121-2163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-443-0900
-----------------------------------------------------
Fax | 206-728-1180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 WESTERN AVE SUITE 310
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98121-2163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-443-0900
-----------------------------------------------------
Fax | 206-728-1180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JUDITH WARREN
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 206-443-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY00000741
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------