Provider Demographics
NPI:1740587443
Name:FOX, LISA MARLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARLENE
Last Name:FOX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARLENE
Other - Last Name:LOADENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:221 LAUREL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-8301
Mailing Address - Country:US
Mailing Address - Phone:856-354-0664
Mailing Address - Fax:
Practice Address - Street 1:221 LAUREL RD STE 105
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-8301
Practice Address - Country:US
Practice Address - Phone:856-354-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC00130400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health