=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497993125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULETTE L CHAMBERAS LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2009
-----------------------------------------------------
Last Update Date | 08/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 BEACH ST
-----------------------------------------------------
City | WESTERLY
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02891-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-369-1178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 NORTH RD
-----------------------------------------------------
City | WAKEFIELD
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02879-2164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-369-1178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT000104
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------