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Special Instructions for completing this authorization for the use and disclosure of Psychotherapy Notes. Purpose of Disclosure The reason I am authorizing release is My request 7. Person s Authorized to Make the Disclosure 9. Cynthia Schwartzberg LCSW 455 East Paces Ferry Road NE Suite 204 Atlanta GA 30305 917-816-3534 AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION Page 1 of 2 1. The information that is used and/or disclosed pursuant to this authorization may be...
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Cynthia Schwartzberg LCSW is a licensed clinical social worker.
Anyone who is a licensed clinical social worker like Cynthia Schwartzberg must file their LCSW.
To fill out the Cynthia Schwartzberg LCSW form, one must provide accurate information about their clinical social work practice.
The purpose of the Cynthia Schwartzberg LCSW form is to ensure that licensed clinical social workers are in compliance with regulations.
The Cynthia Schwartzberg LCSW form may require information about the licensee's practice, clients, and any continuing education completed.
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