Healthcare Provider Details

I. General information

NPI: 1700700663
Provider Name (Legal Business Name): HEIDI ELLEN FOX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ASPEN RIDGE DR
HAWLEY PA
18428-8500
US

IV. Provider business mailing address

102 ASPEN RIDGE DR
HAWLEY PA
18428-8500
US

V. Phone/Fax

Practice location:
  • Phone: 570-470-3478
  • Fax:
Mailing address:
  • Phone: 570-470-3478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: