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General NPI Number Information
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NPI Number | 1669898839
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Entity Type | Organization
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Legal Business Name | MARGARET S WARNER PHD LTD
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 5712 S DORCHESTER AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60637-1727
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Country | US
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Telephone | 773-643-8548
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Fax |
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Provider Business Mailing Address
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Address Line | 5712 S DORCHESTER AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60637-1727
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Country | US
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Telephone | 312-720-6362
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Fax |
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Authorized Official
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Title or Position | SECRETRY/TREASURER
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Name | ROMNEY ALLANE PAYNE
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Credential |
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Telephone | 312-720-6362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071-002625
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License Number State | IL
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