Provider Demographics
NPI:1477375772
Name:FOX, EDWARD RILEY
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:RILEY
Last Name:FOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 NEOTOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7575
Mailing Address - Country:US
Mailing Address - Phone:707-571-5581
Mailing Address - Fax:707-571-5531
Practice Address - Street 1:1430 NEOTOMAS AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7575
Practice Address - Country:US
Practice Address - Phone:707-571-5581
Practice Address - Fax:707-571-5531
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)