Active NPI
Jude Chamberlain, PH.D.
- Clinical Psychologist
- Mentor, OH
National Provider Identifier
1669868006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 7289
- Practice address
- 8701 Mentor Ave
Mentor, OH 44060-6103 - Phone
- (440) 266-0770
- Fax
- (440) 266-0257
- NPI assigned
- Apr 13, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 7289 | OH | Primary |
Addresses
Primary practice location
8701 Mentor Ave
Mentor, OH 44060-6103
Mailing address
6509 Marsol Rd
Apt 526
Mayfield Heights, OH 44124-3571
Phone (216) 509-3003
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7289 | Other | OH | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7289 | OH | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| B. Sharif MD, Inc | Past | Accepting new patients | |
| Premier Behavioral Health Services, LLC | Clinical | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychiatry Physician
- Mentor, OH
- NPI 1922287382
-
- Clinical Psychologist
- Mentor, OH
- NPI 1184869786
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428883200000",
"number": "1669868006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6509 MARSOL RD",
"address_2": "APT 526",
"city": "MAYFIELD HEIGHTS",
"state": "OH",
"postal_code": "441243571",
"telephone_number": "216-509-3003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8701 MENTOR AVE",
"city": "MENTOR",
"state": "OH",
"postal_code": "440606103",
"telephone_number": "440-266-0770",
"fax_number": "440-266-0257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMBERLAIN",
"first_name": "JUDE",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-13",
"last_updated": "2015-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "7289",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "7289",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mentor, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.