Healthcare Provider Details

I. General information

NPI: 1700723657
Provider Name (Legal Business Name): CLIFFORD CHAMBERS JR. CPT, CET, CCHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

IV. Provider business mailing address

2389 MAIN ST STE 100
GLASTONBURY CT
06033-4617
US

V. Phone/Fax

Practice location:
  • Phone: 804-753-7773
  • Fax:
Mailing address:
  • Phone: 804-753-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberR7X7D5Y3
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: