Provider Demographics
NPI:1619083128
Name:FIELDS, JANINE P (LCSW)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:P
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6921 FRANKFORD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1623
Mailing Address - Country:US
Mailing Address - Phone:215-332-3240
Mailing Address - Fax:215-332-3241
Practice Address - Street 1:6921 FRANKFORD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1623
Practice Address - Country:US
Practice Address - Phone:215-332-3240
Practice Address - Fax:215-332-3241
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1663370OtherPA BLUE SHIELD
PA4558870000OtherMAGELLAN
PA768602Medicare ID - Type Unspecified