Provider Demographics
NPI:1033366638
Name:CHAMBERS, REBECCA (LCSW; CADC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:LCSW; CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 DREXLER CIR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7843
Mailing Address - Country:US
Mailing Address - Phone:270-982-9495
Mailing Address - Fax:
Practice Address - Street 1:151 DREXLER CIR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7843
Practice Address - Country:US
Practice Address - Phone:270-982-9495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1116101YA0400X
KY40281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02921011Medicaid