Healthcare Provider Details

I. General information

NPI: 1588833842
Provider Name (Legal Business Name): JESSICA FOX MA, ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E MILL DR APT 1A
GREAT NECK NY
11021-4006
US

IV. Provider business mailing address

1 E MILL DR APT 1A
GREAT NECK NY
11021-4006
US

V. Phone/Fax

Practice location:
  • Phone: 917-399-7738
  • Fax:
Mailing address:
  • Phone: 917-399-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number05000002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: