Provider Demographics
NPI:1063866192
Name:FIELD, STEPHANIE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:FIELD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122A NAUBUC AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4246
Mailing Address - Country:US
Mailing Address - Phone:860-266-7296
Mailing Address - Fax:
Practice Address - Street 1:122A NAUBUC AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4246
Practice Address - Country:US
Practice Address - Phone:860-266-7296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003428103TC0700X, 103TA0400X, 103T00000X, 102X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist