MEDICARE: ERIC CHAMBERLAIN JR. LCSW, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	07766-LC	NV
2	1041C0700X	Clinical Social Worker	11110-C	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCADC	OTHER	NV	07766-LC
2	LCSW	OTHER	NV	11110-C

General Provider Information

NPI Number	:	1518631092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CHAMBERLAIN JR. LCSW, LCADC

Provider Business Mailing Address
First Line	:	8701 COUNTRY PINES AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7637
Country	:	US
Telephone Number	:	702-375-6749
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 COUNTRY PINES AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7637
Country	:	US
Telephone Number	:	702-375-6749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	08/19/2024

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