Provider Demographics
NPI:1174343495
Name:FOX, BENSON JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:BENSON
Middle Name:JOSEPH
Last Name:FOX
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 FULTON ST REAR
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1128
Mailing Address - Country:US
Mailing Address - Phone:516-880-2841
Mailing Address - Fax:
Practice Address - Street 1:200 S SERVICE RD STE 110A
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2133
Practice Address - Country:US
Practice Address - Phone:916-362-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-P131639-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist