Provider Demographics
NPI:1376965848
Name:FIELD, EVELYN R (MSED)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:R
Last Name:FIELD
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:LOON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12989-2905
Mailing Address - Country:US
Mailing Address - Phone:518-891-2554
Mailing Address - Fax:
Practice Address - Street 1:299 BLUE SPRUCE DR
Practice Address - Street 2:
Practice Address - City:LOON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12989-2905
Practice Address - Country:US
Practice Address - Phone:518-891-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency