| Minou Rysiew, Lcsw | |
|
1551 Jennings Mill Rd Unit 3200a Resource Valley Watkinsville GA 30677-7282 | |
| (706) 338-6611 | |
| (706) 338-6611 |
| Full Name | Minou Rysiew, Lcsw |
|---|---|
| Speciality | Social Worker |
| Location | 1551 Jennings Mill Rd Unit 3200a, Watkinsville, Georgia |
| Authorized Official Name and Position | Minou J Rysiew (OWNER) |
| Authorized Official Contact | 7063386611 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Minou Rysiew, Lcsw 490 Maple Forge Dr Athens GA 30606-1166 Ph: (706) 338-6611 | Minou Rysiew, Lcsw 1551 Jennings Mill Rd Unit 3200a Resource Valley Watkinsville GA 30677-7282 Ph: (706) 338-6611 |
| NPI Number | 1689867509 |
|---|---|
| Provider Enumeration Date | 08/23/2007 |
| Last Update Date | 03/09/2015 |
| Medicare PECOS PAC ID | 6507935194 |
|---|---|
| Medicare Enrollment ID | O20080522000216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689867509 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSW003390 (Georgia) | Primary |
| Provider Name | Minou J Rysiew |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154472413 PECOS PAC ID: 5890899686 Enrollment ID: I20070404000242 |
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