Mark Fairfield, LCSW, BCD, a Licensed Clinical Social Work Corporation

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

LCS19969 Issued in CA

Legal business name

MARK FAIRFIELD, LCSW, BCD, A LICENSED CLINICAL SOCIAL WORK CORPORATION

Practice address

612 N Sepulveda Blvd
Ste. 3
Los Angeles, CA 90049-2175

Phone

(310) 339-0609

Fax

(877) 768-2272

NPI assigned

Feb 17, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Fairfield, LCSW

Title

President/Ceo

Phone

(310) 339-0609

Specialties & licenses 1

Addresses

Other names 1

• Mark Fairfield, LCSW, BCD Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234828800000",
    "number": "1174762058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 N SEPULVEDA BLVD",
            "address_2": "STE. 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900492175",
            "telephone_number": "310-339-0609",
            "fax_number": "877-768-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N SEPULVEDA BLVD",
            "address_2": "STE. 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900492175",
            "telephone_number": "310-339-0609",
            "fax_number": "877-768-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK FAIRFIELD, LCSW, BCD, A LICENSED CLINICAL SOCIAL WORK CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-17",
        "last_updated": "2009-02-17",
        "status": "A",
        "authorized_official_last_name": "FAIRFIELD",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "310-339-0609",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "LCS19969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mark Fairfield, LCSW, BCD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Community/Behavioral Health Agency in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Community/Behavioral Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.