Provider Demographics
NPI:1659413037
Name:FOX GANSENBERG, DEBRA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:FOX GANSENBERG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SEVINOR RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:781-990-1909
Mailing Address - Fax:781-990-1909
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3590
Practice Address - Country:US
Practice Address - Phone:781-438-0038
Practice Address - Fax:781-438-2398
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist