Provider Demographics
NPI:1558435909
Name:FOX, ROBYN LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:LESLIE
Last Name:FOX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBYN
Other - Middle Name:LESLIE
Other - Last Name:MENDELSOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:17 GARVEY PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3620
Mailing Address - Country:US
Mailing Address - Phone:201-694-9282
Mailing Address - Fax:201-857-4809
Practice Address - Street 1:17 GARVEY PL
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3620
Practice Address - Country:US
Practice Address - Phone:201-694-9282
Practice Address - Fax:201-857-4809
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013825103TC2200X
NJ35S100447700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid