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Victoria L Mamin

Social Worker

Behavioral Health & Social Service Providers

9020 Overlook Blvd Ste 130, Brentwood, TN 37027-3259

PECOS Enrollment

This provider is enrolled in PECOS as VICTORIA MAMIN.

Based on the most recent information from CMS, provider Victoria L Mamin is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:54 AM.

Profile Details

Provider ID
1659674661
Provider Type
Individual
Full Name
Mamin, Victoria L
Credential
LCSW

Gender
Female
Sole Proprietor
No
Enumeration Date
12/13/2010
Last Updated
2/27/2025

Contact Information

Practice Location

9020 Overlook Blvd Ste 130, Brentwood, TN 37027-3259

(865) 588-3173

Unlisted Fax

Mailing Location

2100 Charlie Hall Blvd, Charleston, SC 29414

(843) 816-3843

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 9356 Tennessee
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License 16764 South Carolina

Provider Identifiers

ID	Description	Issuer
ID 1760596480	Description Medicaid	Issuer Unlisted South Carolina

Victoria L Mamin

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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