Provider Demographics
NPI:1851702294
Name:ROBERTSON, MEGAN R (LISW-S)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:R
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:R
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:1385 KING AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212
Mailing Address - Country:US
Mailing Address - Phone:614-306-8376
Mailing Address - Fax:
Practice Address - Street 1:1385 KING AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212
Practice Address - Country:US
Practice Address - Phone:614-306-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08003561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical