Provider Demographics
NPI:1417253535
Name:FOX, SUSAN T (MS ED)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:FOX
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 E BEECH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3604
Mailing Address - Country:US
Mailing Address - Phone:516-432-7533
Mailing Address - Fax:516-432-7533
Practice Address - Street 1:438 E BEECH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3604
Practice Address - Country:US
Practice Address - Phone:516-432-7533
Practice Address - Fax:516-432-7533
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X, 171W00000X, 174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No174400000XOther Service ProvidersSpecialist