Healthcare Provider Details

I. General information

NPI: 1386396869
Provider Name (Legal Business Name): JAMES SR ROSS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BAILY RD
LANSDOWNE PA
19050-2801
US

IV. Provider business mailing address

45 BAILY RD
LANSDOWNE PA
19050-2801
US

V. Phone/Fax

Practice location:
  • Phone: 267-983-7059
  • Fax:
Mailing address:
  • Phone: 267-983-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW023001
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: