MEDICARE: YSSIS EL

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

General Provider Information

NPI Number	:	1477286508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YSSIS EL

Provider Business Mailing Address
First Line	:	3390 N BERKELEY LAKE RD NW
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-3006
Country	:	US
Telephone Number	:	470-704-5031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3390 N BERKELEY LAKE RD NW
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-3006
Country	:	US
Telephone Number	:	470-704-5031
Fax Number	:

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

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	07/07/2022

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Directions to “ YSSIS EL ” Practice Location

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