Provider Demographics
NPI:1114818598
Name:ROBERTSON, DISHA AMELIA
Entity type:Individual
Prefix:
First Name:DISHA
Middle Name:AMELIA
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JACE
Other - Middle Name:ADAM
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5047 N CENTRAL PARK AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5540
Mailing Address - Country:US
Mailing Address - Phone:813-300-3497
Mailing Address - Fax:
Practice Address - Street 1:4908 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2506
Practice Address - Country:US
Practice Address - Phone:773-205-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker