Provider Demographics
NPI:1407862303
Name:CHAMBERLAIN, MAUREEN COURTENAY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:COURTENAY
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 MEDICAL CAMPUS RD 2989
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6710
Mailing Address - Country:US
Mailing Address - Phone:301-766-7600
Mailing Address - Fax:301-766-7702
Practice Address - Street 1:251 E ANTIETAM ST
Practice Address - Street 2:5D
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5724
Practice Address - Country:US
Practice Address - Phone:301-766-7600
Practice Address - Fax:301-766-7702
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPHCS9031546OtherPHCS
MD000395600Medicaid
MD614437-01OtherBCBS
MD121724OtherJOHN HOPKINS HEALTHCARE
MD000395600Medicaid