Individual
PROF. MARY ELLEN WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4348 ELECTRIC RD, ROANOKE, VA 24018-0720
(540) 769-0976
(540) 857-5385
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810008462
VA
103TC0700X
Clinical Psychologist
633
SC
103TF0000X
Family Psychologist
633
SC
103TS0200X
School Psychologist
633
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PS0409
—
SC
Enumeration date
09/20/2006
Last updated
04/11/2024
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