Provider Demographics
NPI:1225825961
Name:ROBLES, MIRANDA (LSW)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:
Last Name:ROBLES
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 1:2434 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2942
Mailing Address - Country:US
Mailing Address - Phone:773-584-4178
Mailing Address - Fax:773-269-6891
Practice Address - Street 1:2434 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2942
Practice Address - Country:US
Practice Address - Phone:773-584-4178
Practice Address - Fax:773-269-6891
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
IL150110978104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker