MEDICARE: MRS. DEBRA L FOX LCSW

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	1041C0700X	Clinical Social Worker	SW 8023	FL
2	1041C0700X	Clinical Social Worker	R033108	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	AB354	OTHER	FL	MEDICARE RENDERING PROVID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	052344	OTHER	FL	VALUE OPTIONS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	103958735	OTHER	FL	UNITED BEHAVIORAL HEALTH
5	7401290	OTHER	NY	GHI

General Provider Information

NPI Number	:	1568450864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA L FOX LCSW

Provider Business Mailing Address
First Line	:	8401 LAKE WORTH RD
Second Line	:	SUITE 219
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2400
Country	:	US
Telephone Number	:	561-312-6622
Fax Number	:	561-713-1175

Provider Business Practice Location Address
First Line	:	8401 LAKE WORTH RD
Second Line	:	SUITE 219
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2400
Country	:	US
Telephone Number	:	561-312-6622
Fax Number	:	561-713-1175

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/18/2011

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Directions to “ MRS. DEBRA L FOX LCSW” Practice Location

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