Provider Demographics
NPI:1598977571
Name:REDFIELD, WILLIAM C (MSW, M DIV)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:REDFIELD
Suffix:
Gender:M
Credentials:MSW, M DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 LEDYARD AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2216
Mailing Address - Country:US
Mailing Address - Phone:315-637-3019
Mailing Address - Fax:
Practice Address - Street 1:106 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2004
Practice Address - Country:US
Practice Address - Phone:315-637-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0438411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical