Provider Demographics
NPI:1700633534
Name:ANDERSON, MEG ROTENBERG
Entity type:Individual
Prefix:
First Name:MEG
Middle Name:ROTENBERG
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 MEMORIAL DR SE UNIT B10
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2289
Mailing Address - Country:US
Mailing Address - Phone:404-931-9592
Mailing Address - Fax:
Practice Address - Street 1:1493 MCLENDON AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2154
Practice Address - Country:US
Practice Address - Phone:404-931-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003649101YP2500X
NY0968551041C0700X
GA0037931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional