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NPI Code Detail

MEDICARE: AMY RENE LCSW

MEDICARE:   AMY  RENE  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
11041C0700XClinical Social WorkerCSW3547GA

General Provider Information

NPI Number : 1790179224
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY RENE LCSW
Provider Business Mailing Address
First Line : 690 COURTENAY DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3421
Country : US
Telephone Number : 404-564-0677
Fax Number :
Provider Business Practice Location Address
First Line : 690 COURTENAY DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3421
Country : US
Telephone Number : 404-564-0677
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2015
Last Update Date : 03/23/2015

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Directions to “ AMY RENE LCSW” Practice Location

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