Charles C. Chamberlain, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301012160 Issued in MI

Practice address

1750 S Telegraph Rd
Suite 101
Bloomfield Hills, MI 48302-0166

Phone

(248) 451-9085

Fax

(248) 451-9089

NPI assigned

Jun 22, 2011

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308700800000",
    "number": "1790071306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6770 BIRMINGHAM CLUB DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013119",
            "telephone_number": "248-225-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 S TELEGRAPH RD",
            "address_2": "SUITE 101",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483020166",
            "telephone_number": "248-451-9085",
            "fax_number": "248-451-9089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMBERLAIN",
        "first_name": "CHARLES",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301012160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Bloomfield Hills, MI
• Providers in Bloomfield Hills, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2011; 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.