Provider Demographics
NPI:1437150539
Name:CHAMBERLIN, SUSAN J (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:CHAMBERLIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01951-1721
Mailing Address - Country:US
Mailing Address - Phone:978-462-0166
Mailing Address - Fax:978-499-2177
Practice Address - Street 1:28 GREEN ST
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01951-1721
Practice Address - Country:US
Practice Address - Phone:978-462-0166
Practice Address - Fax:978-499-2177
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1101OtherBLUE CROSS BLUE SHIELD