MEDICARE: ADRIANA M WARREN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW61093890	WA

General Provider Information

NPI Number	:	1114605599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANA M WARREN LICSW

Provider Business Mailing Address
First Line	:	4915 N VISTA GRANDE DR
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99027-5001
Country	:	US
Telephone Number	:	509-216-5781
Fax Number	:

Provider Business Practice Location Address
First Line	:	4915 N VISTA GRANDE DR
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99027-5001
Country	:	US
Telephone Number	:	509-216-5781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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