Provider Demographics
NPI:1720723505
Name:CHAMBERLAIN-GORDON, LISA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:E
Last Name:CHAMBERLAIN-GORDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LIONI CT
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5432
Mailing Address - Country:US
Mailing Address - Phone:848-231-2174
Mailing Address - Fax:
Practice Address - Street 1:482 SPRINGFIELD AVE FL 2
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2601
Practice Address - Country:US
Practice Address - Phone:908-273-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling