Provider Demographics
NPI:1568814317
Name:ROBERSON, FALON AMELIA (LMSW, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:FALON
Middle Name:AMELIA
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMSW, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 DAVIS CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-6806
Mailing Address - Country:US
Mailing Address - Phone:901-517-2160
Mailing Address - Fax:
Practice Address - Street 1:5170 SANDERLIN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4360
Practice Address - Country:US
Practice Address - Phone:901-517-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN330103K00000X
TN0006261301041S0200X
TN1-16-24900103K00000X
MS200010103K00000X
TN10650104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker