Provider Demographics
NPI:1598046807
Name:FOX, MEGHAN LEAH (PSYD)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LEAH
Last Name:FOX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:LEAH
Other - Last Name:FOX-RITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:156 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2510
Mailing Address - Country:US
Mailing Address - Phone:585-633-8758
Mailing Address - Fax:
Practice Address - Street 1:1580 ELMWOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3620
Practice Address - Country:US
Practice Address - Phone:585-633-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022822103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05445827Medicaid
FLMH 11490OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
NY022822OtherNEW YORK STATE EDUCATION DEPARTMENT