Provider Demographics
NPI:1235259904
Name:FOX, JUDITH A (MSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:FOX
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 GREENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9704
Mailing Address - Country:US
Mailing Address - Phone:315-685-8219
Mailing Address - Fax:315-685-8219
Practice Address - Street 1:1217 GREENFIELD LN
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9704
Practice Address - Country:US
Practice Address - Phone:315-685-8219
Practice Address - Fax:315-685-8219
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW152431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52371BMedicare ID - Type Unspecified