Provider Demographics
NPI:1932552882
Name:CHAMBERLIN, CLIFTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:
Last Name:CHAMBERLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 NORFOLK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6015
Mailing Address - Country:US
Mailing Address - Phone:301-351-4694
Mailing Address - Fax:
Practice Address - Street 1:7801 NORFOLK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6015
Practice Address - Country:US
Practice Address - Phone:301-351-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05378103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist