=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477439602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN MARIE ROBERSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2025
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1774 MELLWOOD AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40206-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-459-9635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8032 PALERMO TRL
-----------------------------------------------------
City | SELLERSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47172-8946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-252-9152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 260023
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------