Provider Demographics
NPI:1679753156
Name:CHAMBERS, GERARD ANTHONY JR (PSY D, PHD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:ANTHONY
Last Name:CHAMBERS
Suffix:JR
Gender:M
Credentials:PSY D, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5711
Mailing Address - Country:US
Mailing Address - Phone:321-208-1554
Mailing Address - Fax:
Practice Address - Street 1:2140 41ST AVE
Practice Address - Street 2:STE 200B
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2067
Practice Address - Country:US
Practice Address - Phone:321-208-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8816101YM0800X
CA23778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health