Healthcare Provider Details

I. General information

NPI: 1730805078
Provider Name (Legal Business Name): WHITNEY ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 NASSAU ST
PRINCETON NJ
08540-4623
US

IV. Provider business mailing address

353 NASSAU ST
PRINCETON NJ
08540-4623
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-0060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: