Provider Demographics
NPI:1043887755
Name:CHAMBERS-RIDER, SARA LYN
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYN
Last Name:CHAMBERS-RIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYN
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6140 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3821
Mailing Address - Country:US
Mailing Address - Phone:440-233-7232
Mailing Address - Fax:440-282-4779
Practice Address - Street 1:6140 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3821
Practice Address - Country:US
Practice Address - Phone:440-233-7232
Practice Address - Fax:440-282-4779
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2511873104100000X, 104100000X
OHLCDCIII.162838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)