Healthcare Provider Details

I. General information

NPI: 1245722388
Provider Name (Legal Business Name): DESLYNNE ROBERTS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 SOUTHWICK DR STE 300
MATTESON IL
60443-2279
US

IV. Provider business mailing address

9060 HAYES CT APT 204
MERRILLVILLE IN
46410-0027
US

V. Phone/Fax

Practice location:
  • Phone: 574-387-6239
  • Fax:
Mailing address:
  • Phone: 269-883-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149024564
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: