Provider Demographics
NPI:1740559103
Name:TIFFANY CHAMBERLAIN, ERIN M (MS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:TIFFANY CHAMBERLAIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:M
Other - Last Name:TIFFANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BICENTENNIAL SQ # 3A-S2
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4069
Mailing Address - Country:US
Mailing Address - Phone:603-704-3303
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-669-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health