1124167838 NPI number — MS. MARIAN JOAN FOX MSW LICSW

Table of content: MS. MARIAN JOAN FOX MSW LICSW (NPI 1124167838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124167838 NPI number — MS. MARIAN JOAN FOX MSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOX
Provider First Name:
MARIAN
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOX
Provider Other First Name:
MERI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW LICSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1124167838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 GARFIELD ST
Provider Second Line Business Mailing Address:
#2
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138-1818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-876-0222
Provider Business Mailing Address Fax Number:
617-876-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 GARFIELD ST
Provider Second Line Business Practice Location Address:
#2
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-876-0222
Provider Business Practice Location Address Fax Number:
617-876-0222
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  103067 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 711803 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P01498 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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