Healthcare Provider Details

I. General information

NPI: 1164358487
Provider Name (Legal Business Name): JENNIFER MARA FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SMITH AVE
MOUNT KISCO NY
10549-2813
US

IV. Provider business mailing address

57 UPLAND RD N
BEDFORD NY
10506-1600
US

V. Phone/Fax

Practice location:
  • Phone: 914-523-1090
  • Fax:
Mailing address:
  • Phone: 914-523-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: