Provider Demographics
NPI:1114357985
Name:CHAMBERLAIN, BRADLEY A (LISW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:A
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4914
Mailing Address - Country:US
Mailing Address - Phone:214-743-6146
Mailing Address - Fax:
Practice Address - Street 1:645 NE BROOKSHIRE DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8761
Practice Address - Country:US
Practice Address - Phone:469-585-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX514721041C0700X
IA0859381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical