1912180167 NPI number — CHERYL L CHAMBERS LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912180167 NPI number — CHERYL L CHAMBERS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMBERS
Provider First Name:
CHERYL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOFLAND
Provider Other First Name:
CHERYL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912180167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 S DUPONT BLVD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19963-1704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-422-2888
Provider Business Mailing Address Fax Number:
302-422-3888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 S DUPONT BLVD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19963-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-422-2888
Provider Business Practice Location Address Fax Number:
302-422-3888
Provider Enumeration Date:
12/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: Q1-0000926 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 250731695 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250726142 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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