Provider Demographics
NPI:1497970065
Name:FIELD, SAMUEL GEORGE (MA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:GEORGE
Last Name:FIELD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W WASHINGTON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4350
Mailing Address - Country:US
Mailing Address - Phone:906-228-8881
Mailing Address - Fax:906-228-4549
Practice Address - Street 1:102 W WASHINGTON ST STE 106
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-228-8881
Practice Address - Fax:906-228-4549
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003314103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI347865000OtherMAGELLAN MIS NUMBER