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General NPI Number Information
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NPI Number | 1063154995
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Entity Type | Organization
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Legal Business Name | TRACEY L ROSS LMHC LLC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 22 MOUNT AUBURN ST
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City | WATERTOWN
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State | MA
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Zip | 02472-3992
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Country | US
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Telephone | 781-929-5616
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Fax |
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Provider Business Mailing Address
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Address Line | 15 MAIN ST UNIT 237
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City | WATERTOWN
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State | MA
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Zip | 02472-4403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TRACEY ROSS
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Credential |
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Telephone | 781-929-5616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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