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General NPI Number Information
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NPI Number | 1003347949
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Entity Type | Organization
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Legal Business Name | ROSS PSYCHOLOGICAL GROUP, INC.
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 1123 EMERSON ST STE 202
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City | EVANSTON
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State | IL
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Zip | 60201-3100
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Country | US
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Telephone | 847-859-9094
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 EMERSON ST STE 202
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City | EVANSTON
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State | IL
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Zip | 60201-3100
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Country | US
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Telephone | 847-859-9094
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW R. FARRA
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Credential | PSY.D.
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Telephone | 847-859-9094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007609
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License Number State | IL
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