Provider Demographics
NPI:1164937801
Name:FIELD, STACEY
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:FIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:FIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:828 FEDERAL RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1830
Mailing Address - Country:US
Mailing Address - Phone:203-885-0500
Mailing Address - Fax:
Practice Address - Street 1:828 FEDERAL RD FL 2
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1830
Practice Address - Country:US
Practice Address - Phone:203-885-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3712103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist