Provider Demographics
NPI:1659610251
Name:FIELDS, JERE' (MSP, MSW)
Entity Type:Individual
Prefix:
First Name:JERE'
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MSP, MSW
Other - Prefix:
Other - First Name:JERELYN
Other - Middle Name:E
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSP, MSW
Mailing Address - Street 1:1196 THIRD AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3103
Mailing Address - Country:US
Mailing Address - Phone:619-427-4661
Mailing Address - Fax:619-426-7849
Practice Address - Street 1:1196 THIRD AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3103
Practice Address - Country:US
Practice Address - Phone:619-427-4661
Practice Address - Fax:619-426-7849
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health