Provider Demographics
NPI:1588149231
Name:THE FIELD CLINIC, INC.
Entity type:Organization
Organization Name:THE FIELD CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAGALE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-400-0159
Mailing Address - Street 1:280 BROADWAY LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3007
Mailing Address - Country:US
Mailing Address - Phone:401-400-0159
Mailing Address - Fax:
Practice Address - Street 1:280 BROADWAY LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3007
Practice Address - Country:US
Practice Address - Phone:401-400-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty