Provider Demographics
NPI:1942560255
Name:CHAMBERLYNN, PAMELA LAONORA (MSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LAONORA
Last Name:CHAMBERLYNN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SHAMROCK ST W
Mailing Address - Street 2:M-162
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2658
Mailing Address - Country:US
Mailing Address - Phone:850-329-6638
Mailing Address - Fax:
Practice Address - Street 1:3711 SHAMROCK ST W
Practice Address - Street 2:M-162
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-2658
Practice Address - Country:US
Practice Address - Phone:850-329-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682639368Medicaid