Healthcare Provider Details

I. General information

NPI: 1114267267
Provider Name (Legal Business Name): JEANNE O. ROSS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HOLIDAY CT SUITE 302
ANNAPOLIS MD
21401-7008
US

IV. Provider business mailing address

1544 ALCOVA DR
DAVIDSONVILLE MD
21035-2116
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-1600
  • Fax: 410-266-5554
Mailing address:
  • Phone: 410-507-2389
  • Fax: 410-507-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10895
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: