MEDICARE: JORDAN CARTER FIELDS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6851118367	MI

General Provider Information

NPI Number	:	1205677507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN CARTER FIELDS LCSW

Provider Business Mailing Address
First Line	:	7944 N BOUNDARY RD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-3335
Country	:	US
Telephone Number	:	313-351-2670
Fax Number	:

Provider Business Practice Location Address
First Line	:	7944 N BOUNDARY RD
Second Line	:
City	:	DUNDALK
State	:	MD
Zip	:	21222-3335
Country	:	US
Telephone Number	:	313-351-2670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/11/2026

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