Healthcare Provider Details

I. General information

NPI: 1013641018
Provider Name (Legal Business Name): MAGGIE ROSS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 43RD ST
PHILADELPHIA PA
19104-4408
US

IV. Provider business mailing address

927 S FARRAGUT ST APT 2R2R2R
PHILADELPHIA PA
19143-3636
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-7504
  • Fax:
Mailing address:
  • Phone: 347-989-6897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW022593
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: