MEDICARE: NANCY JOHNSON WARREN PHD

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	103TH0100X	Health Service Psychologist	23751	TX
2	103TC0700X	Clinical Psychologist	23751	TX
3	103TP0814X	Psychoanalysis Psychologist	23751	TX
4	103TC0700X	Clinical Psychologist	1190	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285743997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JOHNSON WARREN PHD

Provider Business Mailing Address
First Line	:	PO BOX 751461
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1461
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 PRESIDENT ST
Second Line	:	INSTITUTE OF PSYCHIATRY, 5 SOUTH
City	:	CHARLESTON
State	:	SC
Zip	:	29425-5712
Country	:	US
Telephone Number	:	843-792-0195
Fax Number	:	843-792-4190

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/22/2020

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