Provider Demographics
NPI:1811779044
Name:CHAMBERLAIN, ELIZABETH MERCY
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MERCY
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CIRCLE LN APT 33A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-2211
Mailing Address - Country:US
Mailing Address - Phone:845-380-1732
Mailing Address - Fax:
Practice Address - Street 1:200 GREAT OAKS BLVD STE 215
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5969
Practice Address - Country:US
Practice Address - Phone:518-218-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health