Healthcare Provider Details

I. General information

NPI: 1265507859
Provider Name (Legal Business Name): LORI CHAMBERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEST CAMPBELL AVE., STE 201
CAMPBELL CA
95008
US

IV. Provider business mailing address

1600 WEST CAMPBELL AVE., STE 201
CAMPBELL CA
95008
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-4914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 29304
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: