Provider Demographics
NPI:1417230756
Name:FOX, LYDIA ANN (BCBA, MA)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ANN
Last Name:FOX
Suffix:
Gender:F
Credentials:BCBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 AMESBURY PL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-1106
Mailing Address - Country:US
Mailing Address - Phone:317-409-6151
Mailing Address - Fax:
Practice Address - Street 1:4530 AMESBURY PL
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46062-1106
Practice Address - Country:US
Practice Address - Phone:317-409-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-11-8239103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst