Provider Demographics
NPI:1417148966
Name:FOX, NICHOLAS LYNN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11525 BROOKSHIRE AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4985
Mailing Address - Country:US
Mailing Address - Phone:562-904-7660
Mailing Address - Fax:562-904-7693
Practice Address - Street 1:11525 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4985
Practice Address - Country:US
Practice Address - Phone:562-904-7660
Practice Address - Fax:562-904-7693
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical