Healthcare Provider Details

I. General information

NPI: 1326967191
Provider Name (Legal Business Name): JEROME CHAMBERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

IV. Provider business mailing address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-4300
  • Fax:
Mailing address:
  • Phone: 202-388-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004764
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: