MEDICARE: MS. SUSANAH DESILVA 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	CSW003220	GA

General Provider Information

NPI Number	:	1205841780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSANAH DESILVA LCSW

Provider Business Mailing Address
First Line	:	3863 GA-138
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-9058
Country	:	US
Telephone Number	:	470-651-6704
Fax Number	:	844-492-1148

Provider Business Practice Location Address
First Line	:	1311 PEBBLE RIDGE LN
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-6121
Country	:	US
Telephone Number	:	470-651-6704
Fax Number	:	844-492-1148

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	09/27/2024

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