Provider Demographics
NPI:1780872135
Name:FOX, FELISE NAN (LCSW,BCD)
Entity type:Individual
Prefix:MRS
First Name:FELISE
Middle Name:NAN
Last Name:FOX
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ATLANTIC AVE
Mailing Address - Street 2:SUITE NORTH
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3505
Mailing Address - Country:US
Mailing Address - Phone:516-593-0839
Mailing Address - Fax:516-867-5538
Practice Address - Street 1:200 ATLANTIC AVE
Practice Address - Street 2:SUITE NORTH
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3505
Practice Address - Country:US
Practice Address - Phone:516-593-0839
Practice Address - Fax:516-867-5538
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO17871-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN04231Medicare PIN