MEDICARE: DONNA M. CHAMBERS LCSW

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	0904003407	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	089412	OTHER	VA	SENTARA
2	4945131	OTHER	VA	VIRGINIA PREMIER
3	207294	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1609917962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M. CHAMBERS LCSW

Provider Business Mailing Address
First Line	:	10299 WOODMAN RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-4419
Country	:	US
Telephone Number	:	804-727-8500
Fax Number	:	804-727-8580

Provider Business Practice Location Address
First Line	:	4825 S LABURNUM AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23231-2713
Country	:	US
Telephone Number	:	804-222-2607
Fax Number	:	804-236-9118

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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