Provider Demographics
NPI:1053436915
Name:FIELDSMITH, SUSAN M (LMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FIELDSMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-1379
Mailing Address - Country:US
Mailing Address - Phone:508-693-5300
Mailing Address - Fax:508-696-0003
Practice Address - Street 1:40 RED PONY RD.
Practice Address - Street 2:
Practice Address - City:WEST TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02575-1379
Practice Address - Country:US
Practice Address - Phone:508-693-5300
Practice Address - Fax:508-696-0003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA012336OtherHARVARD PILGRIM
MA1895303Medicaid
MALMO555OtherBLUE CROSS BLUE SHIELD