Provider Demographics
NPI:1730326059
Name:FIELD, ETHAN M (LICSW)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:M
Last Name:FIELD
Suffix:
Gender:M
Credentials:LICSW
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 23
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-0023
Mailing Address - Country:US
Mailing Address - Phone:781-329-4774
Mailing Address - Fax:781-329-9153
Practice Address - Street 1:990 WASHINGTON ST
Practice Address - Street 2:SUITE 209
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6714
Practice Address - Country:US
Practice Address - Phone:781-329-4774
Practice Address - Fax:781-329-9153
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical