Provider Demographics
NPI:1174757488
Name:WARREN, PAMELA (PHD, LCSW, LISW, M)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:PHD, LCSW, LISW, M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N. MADISON RD.
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960
Mailing Address - Country:US
Mailing Address - Phone:540-661-3465
Mailing Address - Fax:540-829-5440
Practice Address - Street 1:311 N. MADISON RD.
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960
Practice Address - Country:US
Practice Address - Phone:540-661-3465
Practice Address - Fax:540-672-1196
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0008321041C0700X
VA09040071561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945361Medicaid
VA023036R23Medicare PIN