Provider Demographics
NPI:1144567512
Name:BORAK, BECKY GINSBERG (MED)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:GINSBERG
Last Name:BORAK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:RENEE
Other - Last Name:MELNYK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:25 POINTE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2755
Mailing Address - Country:US
Mailing Address - Phone:404-932-4140
Mailing Address - Fax:
Practice Address - Street 1:25 POINTE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2755
Practice Address - Country:US
Practice Address - Phone:404-932-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-16-21587103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty