Provider Demographics
NPI:1275726150
Name:CHAMBERLAIN, LAURA ELISE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELISE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4702
Mailing Address - Country:US
Mailing Address - Phone:505-436-0607
Mailing Address - Fax:801-401-7850
Practice Address - Street 1:10815 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4702
Practice Address - Country:US
Practice Address - Phone:505-436-0607
Practice Address - Fax:801-401-7850
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9386717-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical