Provider Demographics
NPI:1871661082
Name:CHAMBERLAIN-CLEMENTS, LAURIE DANENE (MSW ACSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:DANENE
Last Name:CHAMBERLAIN-CLEMENTS
Suffix:
Gender:F
Credentials:MSW ACSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 E MONROE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7249
Mailing Address - Country:US
Mailing Address - Phone:989-839-2894
Mailing Address - Fax:
Practice Address - Street 1:2603 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6903
Practice Address - Country:US
Practice Address - Phone:989-631-2320
Practice Address - Fax:989-631-9903
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010173051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP28310001Medicare ID - Type Unspecified