MEDICARE: CHARLES LAWRENCE FIELD PH.D.

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	103T00000X	Psychologist	001574	CT

General Provider Information

NPI Number	:	1568528859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES LAWRENCE FIELD PH.D.

Provider Business Mailing Address
First Line	:	469 BUCKLAND RD
Second Line	:	SUITE 106
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3737
Country	:	US
Telephone Number	:	860-644-6610
Fax Number	:	860-648-9232

Provider Business Practice Location Address
First Line	:	469 BUCKLAND RD
Second Line	:	SUITE 106
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3737
Country	:	US
Telephone Number	:	860-644-6610
Fax Number	:	860-648-9232

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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