Provider Demographics
NPI:1952448185
Name:FIELDS, CAROLYN JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JEAN
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 1:500 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1520
Mailing Address - City:CHGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-373-1606
Mailing Address - Fax:312-467-9534
Practice Address - Street 1:500 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1520
Practice Address - City:CHGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-373-1606
Practice Address - Fax:312-467-9534
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6120103T00000X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist