MEDICARE: MARTHA DORIAN ROSS MS, BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1464	NC
2	103K00000X	Behavior Analyst	1-18-29808	CO
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1144726449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA DORIAN ROSS MS, BCBA, LBA

Provider Business Mailing Address
First Line	:	542 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:	901-262-8421
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 SEABOARD LN
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8281
Country	:	US
Telephone Number	:	901-262-8421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	01/30/2025

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