Healthcare Provider Details

I. General information

NPI: 1174416580
Provider Name (Legal Business Name): LAUREN ROSS M.S.ED., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BROADWAY FL 2
NEW YORK NY
10013-2562
US

IV. Provider business mailing address

447 BROADWAY, 2ND FLOOR #1051
NEW YORK NY
10013
US

V. Phone/Fax

Practice location:
  • Phone: 860-543-2831
  • Fax:
Mailing address:
  • Phone: 860-543-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: