Provider Demographics
NPI:1699544270
Name:CHAMES, JACOB (LMSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:CHAMES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 BANEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3828
Mailing Address - Country:US
Mailing Address - Phone:954-829-9995
Mailing Address - Fax:
Practice Address - Street 1:1925 OLD VALLEY RD FL 2
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:MD
Practice Address - Zip Code:21153-0670
Practice Address - Country:US
Practice Address - Phone:954-829-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker