Provider Demographics
NPI:1669652160
Name:CHAMBERLAIN, DONNA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:MASSEY
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:15302 STORM DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2742
Mailing Address - Country:US
Mailing Address - Phone:512-786-6185
Mailing Address - Fax:
Practice Address - Street 1:15302 STORM DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2742
Practice Address - Country:US
Practice Address - Phone:512-786-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX297021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194668301Medicaid
TX194668301Medicaid