Provider Demographics
NPI:1457808404
Name:FOX, JUSTINE (LSW)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S BROAD ST APT 304
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2248
Mailing Address - Country:US
Mailing Address - Phone:732-995-3333
Mailing Address - Fax:
Practice Address - Street 1:721 S 17TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2015
Practice Address - Country:US
Practice Address - Phone:732-995-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133741104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker