=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841747797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NINA J FOX LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2016
-----------------------------------------------------
Last Update Date | 10/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10799 N 90TH ST STE 100
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-6110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-804-0326
-----------------------------------------------------
Fax | 480-284-5330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8350 E RAINTREE DR STE 130
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-2692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-338-9699
-----------------------------------------------------
Fax | 561-282-3238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LMSW-13917
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW-18213
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------