Individual provider Active NPI

Jeridith Dionne Warren, PH.D.

  • Clinical Psychologist
  • Dallas, TX
National Provider Identifier
1598990806
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
32218 Issued in TX
Practice address
12700 Hillcrest Rd
Suite 212
Dallas, TX 75230-2033
Phone
(214) 738-7017
NPI assigned
May 17, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 32218 TX
School Psychologist 103TS0200X 31809 TX
Clinical Psychologist 103TC0700X 32218 TX Primary

Addresses

Primary practice location

12700 Hillcrest Rd
Suite 212
Dallas, TX 75230-2033

Mailing address

4605 Fordham Dr
Garland, TX 75042-4550
Phone (214) 738-7017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130311000371 TX Practitioner - Clinical Psychologist 3173530144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
91.17 of 100Reported as group
Quality
83.48
Improvement activities
40
Cost
67.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
32218TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Oaks Geriatric Services P C Clinical CurrentSince Feb 2, 2015 Accepting new patients
Deer Oaks Mental Health Associates PC Clinical Past Accepting new patients

Locations

7272 Wurzbach Rd
Ste 706
San Antonio, TX 78240
Phone (210) 615-3401

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1598990806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 FORDHAM DR",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750424550",
            "telephone_number": "214-738-7017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 HILLCREST RD",
            "address_2": "SUITE 212",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752302033",
            "telephone_number": "214-738-7017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "JERIDITH",
        "middle_name": "DIONNE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-17",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "32218",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "TX",
            "license": "31809",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "32218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.