Provider Demographics
NPI:1083336143
Name:FONTAINE, LENOX ABRAHAM
Entity Type:Individual
Prefix:
First Name:LENOX
Middle Name:ABRAHAM
Last Name:FONTAINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 E VIA DE VENTURA STE 280
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4541
Mailing Address - Country:US
Mailing Address - Phone:480-210-7266
Mailing Address - Fax:
Practice Address - Street 1:8700 E VIA DE VENTURA STE 280
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4541
Practice Address - Country:US
Practice Address - Phone:480-210-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19634104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker