Provider Demographics
NPI:1568686210
Name:FOX, KENNETH L (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:FOX
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12613 CELTIC CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3769
Mailing Address - Country:US
Mailing Address - Phone:301-283-8028
Mailing Address - Fax:
Practice Address - Street 1:4400 EAST-WEST HWY
Practice Address - Street 2:SUITE 329
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4052
Practice Address - Country:US
Practice Address - Phone:301-283-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD688053Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION