Healthcare Provider Details

I. General information

NPI: 1922121649
Provider Name (Legal Business Name): LAURIE ANN ROSS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SAVIERS RD
OXNARD CA
93033-3608
US

IV. Provider business mailing address

10789 SUNFLOWER ST
VENTURA CA
93004-4807
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-2253
  • Fax:
Mailing address:
  • Phone: 661-886-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: