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General NPI Number Information
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NPI Number | 1952010241
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Entity Type | Individual
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Provider Name | DERRICK WARREN
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Gender | Male
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 1320 WASHINGTON AVE
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City | CLEVELAND
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State | OH
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Zip | 44113-2333
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Country | US
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Telephone | 213-727-2108
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 WOODLAND AVE APT 203
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City | CLEVELAND
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State | OH
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Zip | 44104-3084
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Country | US
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Telephone | 216-762-3164
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | APS.003689
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License Number State | OH
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