Provider Demographics
NPI:1396753752
Name:FOX, DIANNE LYNN (MSW)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:LYNN
Last Name:FOX
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CECIL AVE
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-2770
Mailing Address - Country:US
Mailing Address - Phone:410-642-2326
Mailing Address - Fax:
Practice Address - Street 1:505 CECIL AVE
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2770
Practice Address - Country:US
Practice Address - Phone:410-642-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD021781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical