1437331345 NPI number — JUDITH CHAMBERLIN MSW, LCSW

Table of content: JUDITH CHAMBERLIN MSW, LCSW (NPI 1437331345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437331345 NPI number — JUDITH CHAMBERLIN MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAMBERLIN
Provider First Name:
JUDITH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHAMBERLIN
Provider Other First Name:
JUDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1437331345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17752 SKY PARK CIR
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92614-6419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-292-2092
Provider Business Mailing Address Fax Number:
949-587-2815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17752 SKY PARK CIR
Provider Second Line Business Practice Location Address:
SUITE 260
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92614-6419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-292-2092
Provider Business Practice Location Address Fax Number:
949-587-2815
Provider Enumeration Date:
12/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 26665 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)