Provider Demographics
NPI:1063809879
Name:CHAMBERLAIN, FRANCIS (LADC)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC
Mailing Address - Street 1:208 FLYNN AVE
Mailing Address - Street 2:STE 3J
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6013
Practice Address - Country:US
Practice Address - Phone:802-488-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000653101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)