Provider Demographics
NPI:1619480779
Name:FIELD, MARY WADDELL
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:WADDELL
Last Name:FIELD
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 1:617 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1664
Mailing Address - Country:US
Mailing Address - Phone:805-884-8440
Mailing Address - Fax:
Practice Address - Street 1:7167 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1354
Practice Address - Country:US
Practice Address - Phone:805-685-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health