Provider Demographics
NPI:1225029036
Name:FIELDMAN, NANCY PHYLLIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:PHYLLIS
Last Name:FIELDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E HARTSDALE AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2810
Mailing Address - Country:US
Mailing Address - Phone:914-749-6631
Mailing Address - Fax:
Practice Address - Street 1:80 E HARTSDALE AVE
Practice Address - Street 2:STE 105
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2810
Practice Address - Country:US
Practice Address - Phone:914-749-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-01
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV90161Medicare ID - Type Unspecified