MEDICARE: DR. LISA FOX PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	019044	NY

General Provider Information

NPI Number	:	1255624797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA FOX PSY.D.

Provider Business Mailing Address
First Line	:	3824 BARRETT DR
Second Line	:	4K
City	:	RALEIGH
State	:	NC
Zip	:	27609-7220
Country	:	US
Telephone Number	:	917-687-5287
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 GRAMATAN AVE
Second Line	:	4K
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-1840
Country	:	US
Telephone Number	:	917-687-5287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	06/20/2016

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