Provider Demographics
NPI:1134467699
Name:CHAMBERS, THOMAS (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4911 AVON LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2756
Mailing Address - Country:US
Mailing Address - Phone:941-921-0808
Mailing Address - Fax:
Practice Address - Street 1:2033 WOOD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7900
Practice Address - Country:US
Practice Address - Phone:941-677-3366
Practice Address - Fax:941-677-3367
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW33421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical