Healthcare Provider Details

I. General information

NPI: 1356367882
Provider Name (Legal Business Name): JOANNA ROSS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAINSAIL DR
TIVERTON RI
02878-4283
US

IV. Provider business mailing address

63 MAINSAIL DR
TIVERTON RI
02878-4283
US

V. Phone/Fax

Practice location:
  • Phone: 781-254-1092
  • Fax: 401-685-0352
Mailing address:
  • Phone: 781-254-1092
  • Fax: 401-685-0352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2916
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: