Provider Demographics
NPI:1871715441
Name:WARNER, BETH S (PHD)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:S
Last Name:WARNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SHOEMAKER BLDG.
Mailing Address - Street 2:U. OF MD COUNSELING CENTER
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769
Mailing Address - Country:US
Mailing Address - Phone:301-442-3593
Mailing Address - Fax:301-314-9206
Practice Address - Street 1:1107 SHOEMAKER BLDG.
Practice Address - Street 2:U. OF MD COUNSELING CENTER
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769
Practice Address - Country:US
Practice Address - Phone:301-442-3593
Practice Address - Fax:301-314-9206
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGQ33OtherBLUE CROSS BLUE SHIELD
MDF8040001OtherBLUE CROSS BLUE SHIELD