Provider Demographics
NPI:1245406867
Name:CHAMBERLIN, JOHN RAYMOND III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RAYMOND
Last Name:CHAMBERLIN
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 RODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1129
Mailing Address - Country:US
Mailing Address - Phone:619-865-2232
Mailing Address - Fax:
Practice Address - Street 1:5040 RODMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1129
Practice Address - Country:US
Practice Address - Phone:619-865-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA238481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical