MEDICARE: FIELDWELL, A LICENSED CLINICAL SOCIAL WORKER CORPORATION

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

General Provider Information

NPI Number	:	1831057595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIELDWELL, A LICENSED CLINICAL SOCIAL WORKER CORPORATION

Provider Business Mailing Address
First Line	:	2659 PORTAGE BAY E STE 12
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-3050
Country	:	US
Telephone Number	:	916-258-2589
Fax Number	:

Provider Business Practice Location Address
First Line	:	2659 PORTAGE BAY E STE 12
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-3050
Country	:	US
Telephone Number	:	916-258-2589
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES J MCNEIL
Credential	:	LCSW
Telephone Number	:	916-258-2589

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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