Michael Chamberlain, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010508 Issued in IL

Practice address

1025 W Sunnyside Ave Ste 100
Chicago, IL 60640-5684

Phone

(773) 388-1600

Fax

(773) 388-8936

NPI assigned

Apr 19, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Howard Brown Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1306048632
  NPD (past)
• Howard Brown Health Center

  • Health Educator
  • Chicago, IL
  • NPI 1811824121
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1356922561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6851 S EVANS AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606374118",
            "telephone_number": "503-312-1635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 W SUNNYSIDE AVE STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405684",
            "telephone_number": "773-388-1600",
            "fax_number": "773-388-8936"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6851 S Evans Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606374118",
            "country_code": "US",
            "telephone_number": "503-312-1635",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "650 N Dearborn St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606543873",
            "country_code": "US",
            "telephone_number": "312-291-9570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAMBERLAIN",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-19",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "071.010508",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Payton Chalmers
• Zachary Rockow Chalmers
• Clay Debra Chalupa, LCPC
• Masa Chalupa, PT, DPT, OCS
• Siresha Chaluvadi, M.D.
• Stacey Lynn Chamberlain, M.D.
• William H. Chamberlin, MD
• Arshanette Chambers, MSW, LSW
• Cynthia Chambers, LCPC
• Diana Hope Chambers

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.