Provider Demographics
NPI:1003210634
Name:FOX, MATTHEW (CCJP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 S CAMERON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2809
Mailing Address - Country:US
Mailing Address - Phone:717-233-7290
Mailing Address - Fax:717-233-5334
Practice Address - Street 1:99 S CAMERON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2809
Practice Address - Country:US
Practice Address - Phone:717-233-7290
Practice Address - Fax:717-233-5334
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACCJP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)