Healthcare Provider Details

I. General information

NPI: 1063436954
Provider Name (Legal Business Name): BERNADETTE CHAMBERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BERNADETTE BODOGH LCSW

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 FAIRVIEW AVE
EASTON PA
18042-3953
US

IV. Provider business mailing address

2061 FAIRVIEW AVE
EASTON PA
18042-3953
US

V. Phone/Fax

Practice location:
  • Phone: 610-923-0412
  • Fax: 610-923-5188
Mailing address:
  • Phone: 610-923-0412
  • Fax: 610-923-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW000198L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: