Provider Demographics
NPI:1114137098
Name:CHAMBERLAIN, JOHN MARTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:CHAMBERLAIN
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 1:8720 GEORGIA AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3638
Mailing Address - Country:US
Mailing Address - Phone:301-495-0266
Mailing Address - Fax:
Practice Address - Street 1:8720 GEORGIA AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3638
Practice Address - Country:US
Practice Address - Phone:301-495-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000161103TC0700X
MD3623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical