MEDICARE: MARYANA KLEYN 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	104100000X	Social Worker	MSW008449	GA

General Provider Information

NPI Number	:	1669049169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANA KLEYN LCSW

Provider Business Mailing Address
First Line	:	260 ELM ST
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2467
Country	:	US
Telephone Number	:	770-887-1668
Fax Number	:	770-781-9937

Provider Business Practice Location Address
First Line	:	775 WEST AVE STE A
Second Line	:
City	:	CARTERSVILLE
State	:	GA
Zip	:	30120-3482
Country	:	US
Telephone Number	:	770-887-1668
Fax Number	:	770-781-9937

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

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	08/21/2023

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Directions to “ MARYANA KLEYN LCSW” Practice Location

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