Provider Demographics
NPI:1861645228
Name:COX, MALISSA (LMSW)
Entity Type:Individual
Prefix:
First Name:MALISSA
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 PARK SOUTH PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4967
Mailing Address - Country:US
Mailing Address - Phone:505-363-9605
Mailing Address - Fax:
Practice Address - Street 1:6105 PARK SOUTH PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4967
Practice Address - Country:US
Practice Address - Phone:505-363-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-068681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool