MEDICARE: LYANN PRIETO 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	CSW007403	GA

General Provider Information

NPI Number	:	1952999302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYANN PRIETO LCSW

Provider Business Mailing Address
First Line	:	1700 FOUNTAIN CT APT 3904
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-1681
Country	:	US
Telephone Number	:	706-580-2124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 FOUNTAIN CT APT 3904
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-1681
Country	:	US
Telephone Number	:	706-580-2124
Fax Number	:

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

Provider Enumeration Date	:	12/31/2020
Last Update Date	:	12/31/2020

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