Provider Demographics
NPI:1922512771
Name:FIELDS, MARC ALAN
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ALAN
Last Name:FIELDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 INTERCHANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3557
Mailing Address - Country:US
Mailing Address - Phone:302-452-3400
Mailing Address - Fax:
Practice Address - Street 1:514 INTERCHANGE BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-3557
Practice Address - Country:US
Practice Address - Phone:302-452-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEBACB275582103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist