MEDICARE: JUDITH A. HANCOX MSW, LCSW, BCETS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	089.0000933	VT
2	101YM0800X	Mental Health Counselor	44SC00866200	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1740404599	OTHER	NJ	MEDICARE INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1740404599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH A. HANCOX MSW, LCSW, BCETS

Provider Business Mailing Address
First Line	:	7959 VT ROUTE 125
Second Line	:
City	:	BRIDPORT
State	:	VT
Zip	:	05734-4401
Country	:	US
Telephone Number	:	802-758-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	7959 VT ROUTE 125
Second Line	:
City	:	BRIDPORT
State	:	VT
Zip	:	05734-4401
Country	:	US
Telephone Number	:	802-758-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	11/20/2019

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