=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366576381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN P. FOX-BOW MA, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 11/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 ROUTE 6
-----------------------------------------------------
City | MAHOPAC
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10541-3850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-584-8124
-----------------------------------------------------
Fax | 914-214-4842
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 474 RUTLEDGE DR
-----------------------------------------------------
City | YORKTOWN HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10598-5012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-962-7297
-----------------------------------------------------
Fax | 914-962-7297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P048330
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------