Provider Demographics
NPI:1043759889
Name:SYEN, AMY FOSSETT (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:FOSSETT
Last Name:SYEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 WILSON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3741
Mailing Address - Country:US
Mailing Address - Phone:859-421-1164
Mailing Address - Fax:
Practice Address - Street 1:3300 OLD MILTON PKWY STE 175
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2423
Practice Address - Country:US
Practice Address - Phone:470-568-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0053571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical