MEDICARE: MICHAEL 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
2	1041C0700X	Clinical Social Worker	5661	TN

General Provider Information

NPI Number	:	1588794572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WARREN

Provider Business Mailing Address
First Line	:	2238 BREWERS LNDG
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-4306
Country	:	US
Telephone Number	:	901-210-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 UNION AVENUE EXT
Second Line	:	STE 1224
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4416
Country	:	US
Telephone Number	:	901-270-4084
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	10/19/2018

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Directions to “ MICHAEL WARREN ” Practice Location

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