Provider Demographics
NPI:1326861717
Name:FIELDS, JENNIFER WILSON (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WILSON
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 WOODMONT AVE # 3F
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3027
Mailing Address - Country:US
Mailing Address - Phone:240-693-5483
Mailing Address - Fax:
Practice Address - Street 1:8030 WOODMONT AVE # 3F
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3027
Practice Address - Country:US
Practice Address - Phone:240-693-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200002929104100000X
VA0903004294104100000X
MD32183104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker