Provider Demographics
NPI:1184271942
Name:ROBERTS, NEHEZI
Entity type:Individual
Prefix:
First Name:NEHEZI
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 N MILWAUKEE AVE APT 2208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4051
Mailing Address - Country:US
Mailing Address - Phone:312-350-8393
Mailing Address - Fax:
Practice Address - Street 1:1165 N MILWAUKEE AVE APT 2208
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4051
Practice Address - Country:US
Practice Address - Phone:312-350-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
19081908OtherNONE