MEDICARE: CRYSTAL K 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	CSW.09924843	CO

General Provider Information

NPI Number	:	1396236295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL K FIELDS LCSW

Provider Business Mailing Address
First Line	:	320 W 37TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-4232
Country	:	US
Telephone Number	:	719-213-7637
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 E WOODMEN RD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8042
Country	:	US
Telephone Number	:	719-716-9058
Fax Number	:

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

Provider Enumeration Date	:	05/25/2018
Last Update Date	:	10/28/2024

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