MEDICARE: DR. DEBORAH L. ROSS PH.D.

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	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	2675	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021229000	OTHER	OH	MAGELLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000146378	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1659303378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH L. ROSS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 660
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44061-0660
Country	:	US
Telephone Number	:	440-460-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 HYDE PARK
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-7536
Country	:	US
Telephone Number	:	440-460-1500
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/06/2024

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