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General NPI Number Information
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NPI Number | 1396199485
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Entity Type | Individual
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Provider Name | MRS. SAMANTHA ROSS
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Gender | Female
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 312 S 4TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-3021
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 8787 BROOKPARK RD
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City | PARMA
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State | OH
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Zip | 44129-6809
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Country | US
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Telephone | 216-739-7000
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 172176
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 172176
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License Number State | KY
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