Healthcare Provider Details

I. General information

NPI: 1619253119
Provider Name (Legal Business Name): BARRY FIELDS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 AVENIDA ALDEA
SANTA FE NM
87507-9449
US

IV. Provider business mailing address

551 W CORDOVA RD # 551
SANTA FE NM
87505-1825
US

V. Phone/Fax

Practice location:
  • Phone: 505-930-2432
  • Fax:
Mailing address:
  • Phone: 505-930-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1159
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: