Provider Demographics
NPI:1174160154
Name:CHAMBERLAIN, CHLOE BRIANN (LISW)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:BRIANN
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1043
Mailing Address - Country:US
Mailing Address - Phone:513-400-2063
Mailing Address - Fax:
Practice Address - Street 1:100 E CAMPUS VIEW BLVD
Practice Address - Street 2:STE 250 PMB 545
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4682
Practice Address - Country:US
Practice Address - Phone:614-594-8759
Practice Address - Fax:614-748-0625
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 1041C0700X
OHI.24056431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical