MEDICARE: SHENA LEVERETT BROWN LCSW, MSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	501944	GA
2	1041C0700X	Clinical Social Worker	CSW003119	GA
3	1041S0200X	School Social Worker	695525	GA

General Provider Information

NPI Number	:	1629265319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENA LEVERETT BROWN LCSW, MSW

Provider Business Mailing Address
First Line	:	2964 PEACHTREE RD NW
Second Line	:	SUITE 510
City	:	ATLANTA
State	:	GA
Zip	:	30305-2153
Country	:	US
Telephone Number	:	770-403-2907
Fax Number	:	770-987-9757

Provider Business Practice Location Address
First Line	:	2964 PEACHTREE RD NW
Second Line	:	SUITE 510
City	:	ATLANTA
State	:	GA
Zip	:	30305-2153
Country	:	US
Telephone Number	:	770-403-2907
Fax Number	:	770-987-9757

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

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	09/26/2007

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