Provider Demographics
NPI:1821814302
Name:FOX, KRISTIN DOMINIQUE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DOMINIQUE
Last Name:FOX
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BRIDGETON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-4810
Mailing Address - Country:US
Mailing Address - Phone:856-825-0255
Mailing Address - Fax:
Practice Address - Street 1:601 BRIDGETON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-4810
Practice Address - Country:US
Practice Address - Phone:856-825-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker