Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4398 | NY |
N | 103TC0700X | Clinical Psychologist | 4398 | NY |
Y | 103G00000X | Clinical Psychologist | 6817 | CA |
Y | 103TC0700X | Clinical Psychologist | 6817 | CA |
NPI | 1003913732 |
---|---|
Provider Name | Dr. Mary M. Fox |
First Address | Studio City, CA 91604-3631 |
Second Address | Studio City, CA 91604-3631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 06/05/2017 |