MEDICARE: TASHIA P CHAMBERS LICSW, LCSW-C

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	LC50079782	DC
2	1041C0700X	Clinical Social Worker	15791	MD

General Provider Information

NPI Number	:	1013489806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHIA P CHAMBERS LICSW, LCSW-C

Provider Business Mailing Address
First Line	:	2211 PINEFIELD CT
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-3358
Country	:	US
Telephone Number	:	240-888-1097
Fax Number	:

Provider Business Practice Location Address
First Line	:	4810 SAINT BARNABAS RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4604
Country	:	US
Telephone Number	:	301-541-0963
Fax Number	:

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/18/2018

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