Provider Demographics
NPI:1649399098
Name:CHABAK-CLAGETT, PAMELA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:CHABAK-CLAGETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 DOE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2865
Mailing Address - Country:US
Mailing Address - Phone:512-288-9499
Mailing Address - Fax:512-288-9404
Practice Address - Street 1:1106 CLAYTON LN
Practice Address - Street 2:SUITE 445E
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1066
Practice Address - Country:US
Practice Address - Phone:512-323-6994
Practice Address - Fax:512-323-9490
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX090011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1726424Medicaid
TX611642Medicare ID - Type Unspecified