Provider Demographics
NPI:1124167838
Name:FOX, MARIAN JOAN (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:JOAN
Last Name:FOX
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:MERI
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LICSW
Mailing Address - Street 1:76 GARFIELD ST
Mailing Address - Street 2:#2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1818
Mailing Address - Country:US
Mailing Address - Phone:617-876-0222
Mailing Address - Fax:617-876-0222
Practice Address - Street 1:76 GARFIELD ST
Practice Address - Street 2:#2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1818
Practice Address - Country:US
Practice Address - Phone:617-876-0222
Practice Address - Fax:617-876-0222
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA711803OtherTUFTS
MAP01498OtherBLUE CROSS
MAP21981Medicare ID - Type Unspecified