Healthcare Provider Details

I. General information

NPI: 1265836902
Provider Name (Legal Business Name): SHEIKETHA ROSS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 E RAMSDELL ST
NEW HAVEN CT
06515-1140
US

IV. Provider business mailing address

30 HAZEL TERRACE SUITE 23
WOODBRIDGE CT
06525-5991
US

V. Phone/Fax

Practice location:
  • Phone: 203-781-4600
  • Fax: 203-781-4624
Mailing address:
  • Phone: 203-819-7650
  • Fax: 203-298-9487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2622
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: