Provider Demographics
NPI:1346463197
Name:FOX, BENJAMIN WALDEN (MA, MHC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WALDEN
Last Name:FOX
Suffix:
Gender:M
Credentials:MA, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SOUTH POMFRET
Mailing Address - State:VT
Mailing Address - Zip Code:05067-0096
Mailing Address - Country:US
Mailing Address - Phone:802-356-0139
Mailing Address - Fax:
Practice Address - Street 1:2095 SOUTH POMFRET RD
Practice Address - Street 2:
Practice Address - City:SOUTH POMFRET
Practice Address - State:VT
Practice Address - Zip Code:05067
Practice Address - Country:US
Practice Address - Phone:802-356-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)