Provider Demographics
NPI:1366053589
Name:FIELDS, JAMES MATTHEW
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:FIELDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 CHAPEL ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6980
Mailing Address - Country:US
Mailing Address - Phone:334-320-1604
Mailing Address - Fax:
Practice Address - Street 1:584 CHAPEL ST APT 3B
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6980
Practice Address - Country:US
Practice Address - Phone:334-320-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2446106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist