MEDICARE: LORI FOX LMSW

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	6801086263	MI

General Provider Information

NPI Number	:	1942348818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI FOX LMSW

Provider Business Mailing Address
First Line	:	454 MAYER RD
Second Line	:
City	:	COLUMBUS
State	:	MI
Zip	:	48063-1509
Country	:	US
Telephone Number	:	810-367-3206
Fax Number	:	586-469-6637

Provider Business Practice Location Address
First Line	:	21885 DUNHAM RD
Second Line	:	SUITE 1
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48036-1030
Country	:	US
Telephone Number	:	586-469-6673
Fax Number	:	586-469-6637

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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