Provider Demographics
NPI:1114030657
Name:FOX, DEBORAH L (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:FOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 TEANECK ROAD
Mailing Address - Street 2:JEWISH FAMILY SERVICE INC
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3626
Mailing Address - Country:US
Mailing Address - Phone:201-837-9090
Mailing Address - Fax:201-837-9393
Practice Address - Street 1:1485 TEANECK ROAD
Practice Address - Street 2:JEWISH FAMILY SERVCE INC
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3626
Practice Address - Country:US
Practice Address - Phone:201-837-9090
Practice Address - Fax:201-837-9393
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045294001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ805461CWNMedicare ID - Type Unspecified