Provider Demographics
NPI:1619253119
Name:FIELDS, BARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 W CORDOVA RD # 551
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1825
Mailing Address - Country:US
Mailing Address - Phone:505-930-2432
Mailing Address - Fax:
Practice Address - Street 1:62 AVENIDA ALDEA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9449
Practice Address - Country:US
Practice Address - Phone:505-930-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical