Provider Demographics
NPI:1730821737
Name:FOX, LAURA (RCSWI)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:912 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5231
Mailing Address - Country:US
Mailing Address - Phone:904-523-1998
Mailing Address - Fax:
Practice Address - Street 1:912 SARATOGA DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5231
Practice Address - Country:US
Practice Address - Phone:904-523-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15440104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker