Provider Demographics
NPI:1265054241
Name:CHAMBERS, BRUCE WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WILLIAM
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 MACKENZIE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5338
Mailing Address - Country:US
Mailing Address - Phone:724-431-0220
Mailing Address - Fax:724-602-4596
Practice Address - Street 1:2009 MACKENZIE WAY STE 100
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-5338
Practice Address - Country:US
Practice Address - Phone:724-431-0220
Practice Address - Fax:724-602-4596
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-3572-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist