Provider Demographics
NPI:1053614545
Name:FOX, PENNY (MFT)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1103
Mailing Address - Country:US
Mailing Address - Phone:650-327-7408
Mailing Address - Fax:650-324-9319
Practice Address - Street 1:1810 BIRCH ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1103
Practice Address - Country:US
Practice Address - Phone:650-327-7408
Practice Address - Fax:650-324-9319
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist