Healthcare Provider Details

I. General information

NPI: 1083887756
Provider Name (Legal Business Name): MERYL MARCI FIELDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 HOPEWELL RD APT 5
SOUTH GLASTONBURY CT
06073-2333
US

IV. Provider business mailing address

36 HOPEWELL RD APT 5
SOUTH GLASTONBURY CT
06073-2333
US

V. Phone/Fax

Practice location:
  • Phone: 860-324-5812
  • Fax:
Mailing address:
  • Phone: 860-324-5812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number006178
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number006178
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: