MEDICARE: STEPHANIE BORER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW004425	GA

General Provider Information

NPI Number	:	1124410535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BORER LCSW

Provider Business Mailing Address
First Line	:	1618 BRAEBURN DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 BRAEBURN DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-2130
Country	:	US
Telephone Number	:	706-705-2859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2015
Last Update Date	:	02/22/2015

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Directions to “ STEPHANIE BORER LCSW” Practice Location

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