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General NPI Number Information
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NPI Number | 1679753156
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Entity Type | Individual
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Provider Name | GERARD ANTHONY CHAMBERS JR. PSY D, PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 2140 41ST AVE STE 200B
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City | CAPITOLA
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State | CA
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Zip | 95010-2067
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Country | US
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Telephone | 321-208-1554
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 DOLPHIN DR
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City | APTOS
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State | CA
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Zip | 95003-5711
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Country | US
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Telephone | 321-208-1554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8816
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 23778
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License Number State | CA
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