Provider Demographics
NPI:1316943582
Name:COX, WILLIAM DALE (EDD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DALE
Last Name:COX
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EAST MAIN STREET
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-898-9133
Mailing Address - Fax:508-898-9633
Practice Address - Street 1:5 EAST MAIN STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-898-9133
Practice Address - Fax:508-898-9633
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1961103TC0700X
103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05016Medicare PIN
MAW05016Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE