Healthcare Provider Details

I. General information

NPI: 1427692953
Provider Name (Legal Business Name): MARY FOX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W SHORTCUT RD
NEWPORT PA
17074-8721
US

IV. Provider business mailing address

212 E SUNBURY ST # 378
MILLERSTOWN PA
17062-9510
US

V. Phone/Fax

Practice location:
  • Phone: 717-567-3524
  • Fax: 717-567-3581
Mailing address:
  • Phone: 717-513-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022720
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136713
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: