Healthcare Provider Details

I. General information

NPI: 1629321617
Provider Name (Legal Business Name): SANDRA MARIE FOX L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WYOMING AVE
KINGSTON PA
18704-3503
US

IV. Provider business mailing address

4711 SR 29 S
NOXEN PA
18636-7805
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-2040
  • Fax:
Mailing address:
  • Phone: 570-814-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015540
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: