MEDICARE: MR. MONTE J. ROBERTS L.C.S.W.

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	149-003029	IL

General Provider Information

NPI Number	:	1427208438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MONTE J. ROBERTS L.C.S.W.

Provider Business Mailing Address
First Line	:	5454 S KIMBARK AVE
Second Line	:	2E
City	:	CHICAGO
State	:	IL
Zip	:	60615-5217
Country	:	US
Telephone Number	:	773-824-3897
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 S KIMBARK AVE
Second Line	:	2E
City	:	CHICAGO
State	:	IL
Zip	:	60615-5217
Country	:	US
Telephone Number	:	773-824-3897
Fax Number	:

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

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	09/25/2008

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