Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
N | 103G00000X | Clinical Psychologist | 7594 | OH |
N | 103TC0700X | Clinical Psychologist | 7594 | OH |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | P.07594 | OH |
NPI | 1104199256 |
---|---|
Provider Name | Jacqueline Newman Warner |
First Address | Dayton, OH 45404-1815 |
Second Address | Dayton, OH 45404-1815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2012 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0236334 | (05) | OH |