MEDICARE: JANELLE WARREN

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	104100000X	Social Worker	128898	NY

General Provider Information

NPI Number	:	1194696963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE WARREN

Provider Business Mailing Address
First Line	:	1468 SW MAIN BLVD # 105-8
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1115
Country	:	US
Telephone Number	:	915-353-5488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 SW MAIN BLVD # 105-8
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-1115
Country	:	US
Telephone Number	:	915-353-5488
Fax Number	:

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

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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Directions to “ JANELLE WARREN ” Practice Location

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