Provider Demographics
NPI:1811979560
Name:FOX, SANDRA MERYL (ACSW LCSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MERYL
Last Name:FOX
Suffix:
Gender:F
Credentials:ACSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6335 MORROWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2504
Mailing Address - Country:US
Mailing Address - Phone:412-421-8233
Mailing Address - Fax:
Practice Address - Street 1:4284 CASTLETOWN SQ S
Practice Address - Street 2:CASTLETOWN SQUARE SO
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1433
Practice Address - Country:US
Practice Address - Phone:412-486-7311
Practice Address - Fax:412-486-8402
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0121751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF0650742Medicare ID - Type Unspecified