Provider Demographics
NPI:1962569517
Name:CHAMBERLAIN, LETITIA ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:LETITIA
Middle Name:ANNE
Last Name:CHAMBERLAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON SQUARE VLG
Mailing Address - Street 2:APT. 8P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1632
Mailing Address - Country:US
Mailing Address - Phone:212-475-0975
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON SQUARE VLG
Practice Address - Street 2:APT. 8P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1632
Practice Address - Country:US
Practice Address - Phone:212-475-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000022103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis