Provider Demographics
NPI:1578139853
Name:FIELDS, DEATRICE MONIQUE
Entity Type:Individual
Prefix:MS
First Name:DEATRICE
Middle Name:MONIQUE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 FAIRVIEW RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-2335
Mailing Address - Country:US
Mailing Address - Phone:610-876-4474
Mailing Address - Fax:
Practice Address - Street 1:630 FAIRVIEW RD STE 202
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-2335
Practice Address - Country:US
Practice Address - Phone:610-876-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician