MEDICARE: MS. ELYSE BRYMAN 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	090400226	VA
2	1041C0700X	Clinical Social Worker	CSW010136	GA

General Provider Information

NPI Number	:	1952038994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELYSE BRYMAN LCSW

Provider Business Mailing Address
First Line	:	630 VILLAGE TRCE NE BLDG 15E
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-1516
Country	:	US
Telephone Number	:	770-609-7885
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 VILLAGE TRCE NE BLDG 15E
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-1516
Country	:	US
Telephone Number	:	770-609-7885
Fax Number	:

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

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	04/26/2026

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