Healthcare Provider Details

I. General information

NPI: 1396649513
Provider Name (Legal Business Name): KENDRA RAYNELLE FIELDS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 EUCLA DR
WALDORF MD
20601-3735
US

IV. Provider business mailing address

716 EUCLA DR
WALDORF MD
20601-3735
US

V. Phone/Fax

Practice location:
  • Phone: 202-277-7373
  • Fax:
Mailing address:
  • Phone: 202-277-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number35601
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: