Provider Demographics
NPI:1487858197
Name:ANDERSEN, GERALDINE MCKEON (MSW LMSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:MCKEON
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MSW LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843
Mailing Address - Country:US
Mailing Address - Phone:517-546-0730
Mailing Address - Fax:
Practice Address - Street 1:2901 E GRAND RIVER
Practice Address - Street 2:ADVANCED BEHAVIORAL MEDICINE
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:517-548-1537
Practice Address - Fax:517-548-9399
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801011170101Y00000X, 101YM0800X
6801011170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist