Provider Demographics
NPI:1609944123
Name:FOX, LILLIAN STERN (MSW)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:STERN
Last Name:FOX
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EDGELL RD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4874
Mailing Address - Country:US
Mailing Address - Phone:508-875-8101
Mailing Address - Fax:508-875-8101
Practice Address - Street 1:5 EDGELL RD
Practice Address - Street 2:SUITE 27
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4874
Practice Address - Country:US
Practice Address - Phone:508-875-8101
Practice Address - Fax:508-875-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04939Medicare UPIN
MAP04939Medicare ID - Type Unspecified