Basic Information
| Provider Information | |||||||||
| NPI: | 1679800577 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | BRANDIE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | UHRICHSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446831818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409222144 | ||||||||
| FaxNumber: | 7409222133 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 E 3RD ST | ||||||||
| Address2: | |||||||||
| City: | UHRICHSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446831818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409222144 | ||||||||
| FaxNumber: | 7409222133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2009 | ||||||||
| LastUpdateDate: | 11/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S 0023446 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.