Provider Demographics
NPI:1104613769
Name:ROBLEDO, DEMETRIUS NATHAN (LSW)
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:NATHAN
Last Name:ROBLEDO
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2217
Mailing Address - Country:US
Mailing Address - Phone:312-226-7984
Mailing Address - Fax:312-980-0482
Practice Address - Street 1:124 N SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2202
Practice Address - Country:US
Practice Address - Phone:312-226-7984
Practice Address - Fax:312-980-0482
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL159116325104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker