Healthcare Provider Details

I. General information

NPI: 1952799314
Provider Name (Legal Business Name): ERIC DAVID FOX LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 KENTWOOD BLVD
BRICK NJ
08724-3123
US

IV. Provider business mailing address

312 KENTWOOD BLVD
BRICK NJ
08724-3123
US

V. Phone/Fax

Practice location:
  • Phone: 732-662-8853
  • Fax:
Mailing address:
  • Phone: 732-662-8853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05736200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: