=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104856962
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA M. WARREN LCSW, LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 02/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6040 CAMP BOWIE BOULEVARD #43
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76116-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-926-4462
-----------------------------------------------------
Fax | 817-246-4177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6040 CAMP BOWIE BOULEVARD #43
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76116-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-926-4462
-----------------------------------------------------
Fax | 817-246-4177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 16319
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S16319
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------