MEDICARE: NEHEZI ROBERTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19081908	OTHER		NONE

General Provider Information

NPI Number	:	1184271942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEHEZI ROBERTS

Provider Business Mailing Address
First Line	:	1165 N MILWAUKEE AVE APT 2208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-4051
Country	:	US
Telephone Number	:	312-350-8393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1165 N MILWAUKEE AVE APT 2208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-4051
Country	:	US
Telephone Number	:	312-350-8393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2019
Last Update Date	:	11/27/2023

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Directions to “ NEHEZI ROBERTS ” Practice Location

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