MEDICARE: MS. AMY LYNNE STERN 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	00002451	GA

General Provider Information

NPI Number	:	1952445306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY LYNNE STERN LCSW

Provider Business Mailing Address
First Line	:	3164 KENSINGTON RD
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1456
Country	:	US
Telephone Number	:	404-643-9939
Fax Number	:	404-296-1667

Provider Business Practice Location Address
First Line	:	3164 KENSINGTON RD
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1456
Country	:	US
Telephone Number	:	404-643-9939
Fax Number	:	404-296-1667

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	08/11/2010

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