Provider Demographics
NPI:1396067211
Name:FOX, SHEREEN MARIAM (LMHC,CASAC,PCSC)
Entity type:Individual
Prefix:MRS
First Name:SHEREEN
Middle Name:MARIAM
Last Name:FOX
Suffix:
Gender:F
Credentials:LMHC,CASAC,PCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BEARD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1603
Mailing Address - Country:US
Mailing Address - Phone:716-830-5830
Mailing Address - Fax:
Practice Address - Street 1:142 BIDWELL PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-1164
Practice Address - Country:US
Practice Address - Phone:716-830-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12630101YA0400X
NY003113-1101YM0800X
NY101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool