Provider Demographics
NPI:1144344516
Name:WARNER, CHARLENE ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:ANN
Last Name:WARNER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 WELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-1724
Mailing Address - Country:US
Mailing Address - Phone:314-533-2229
Mailing Address - Fax:314-533-7496
Practice Address - Street 1:7401 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130
Practice Address - Country:US
Practice Address - Phone:314-725-5277
Practice Address - Fax:314-725-5277
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040245281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499225605Medicaid