Provider Demographics
NPI:1083770739
Name:ANDERSON, ROBERT F
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CHURCH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2000
Mailing Address - Country:US
Mailing Address - Phone:615-340-4677
Mailing Address - Fax:615-284-4679
Practice Address - Street 1:2011 CHURCH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2000
Practice Address - Country:US
Practice Address - Phone:615-340-4677
Practice Address - Fax:615-284-4679
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000031111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3921272Medicaid
TN3921273OtherMEDICARE PTAN
TN3154102OtherBCBS