Healthcare Provider Details

I. General information

NPI: 1164666137
Provider Name (Legal Business Name): JENNIFER ROSS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PARKWAY DR
DOBBS FERRY NY
10522-3517
US

IV. Provider business mailing address

50 PARKWAY DR
DOBBS FERRY NY
10522-3517
US

V. Phone/Fax

Practice location:
  • Phone: 914-231-7415
  • Fax:
Mailing address:
  • Phone: 914-231-7415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number046306-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: