MEDICARE: WANDRA FELICIA CHENAULT MSW, LCSW-R

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	RO41950-1	NY

General Provider Information

NPI Number	:	1568749901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDRA FELICIA CHENAULT MSW, LCSW-R

Provider Business Mailing Address
First Line	:	4665 GUILFORD FOREST DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-7393
Country	:	US
Telephone Number	:	917-464-3549
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 WALL ST STE 537
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-4301
Country	:	US
Telephone Number	:	917-464-3549
Fax Number	:

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

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/01/2021

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