Provider Demographics
NPI:1467623074
Name:FIELDING, BRENDA (MED, LCPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:FIELDING
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3654
Mailing Address - Country:US
Mailing Address - Phone:207-866-5514
Mailing Address - Fax:
Practice Address - Street 1:129 FOREST AVE
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3654
Practice Address - Country:US
Practice Address - Phone:207-866-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2008-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional