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General NPI Number Information
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NPI Number | 1366676173
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Entity Type | Individual
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Provider Name | ROBERT MATTHEW ROSS MS, NCC, LPC
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Gender | Male
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 317 LUZERNE AVE
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City | WEST PITTSTON
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State | PA
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Zip | 18643-2233
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Country | US
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Telephone | 570-332-2475
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Fax | 570-332-2475
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Provider Business Mailing Address
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Address Line | 166 JOHNSON ST FL 2
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City | PITTSTON
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State | PA
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Zip | 18640-1034
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Country | US
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Telephone | 570-332-2475
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Fax | 570-332-2475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC002874
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License Number State | PA
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