MEDICARE: LAUREN KLEBEK LMSW

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	104100000X	Social Worker
2	104100000X	Social Worker	MSW011449	GA

General Provider Information

NPI Number	:	1891479473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN KLEBEK LMSW

Provider Business Mailing Address
First Line	:	3015 PIEDMONT RD NE FL 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2609
Country	:	US
Telephone Number	:	404-793-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 PIEDMONT RD NE FL 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2609
Country	:	US
Telephone Number	:	404-793-0002
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	07/27/2023

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