Provider Demographics
NPI:1457032179
Name:FIELDS, MARTHA ANNE (LGSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 GEORGIA AVE NW APT A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5807
Mailing Address - Country:US
Mailing Address - Phone:336-671-2273
Mailing Address - Fax:
Practice Address - Street 1:488 VIRGINIA AVE SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2751
Practice Address - Country:US
Practice Address - Phone:202-978-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG2000024481041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool