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General NPI Number Information
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NPI Number | 1518385483
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Entity Type | Organization
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Legal Business Name | JEANNE H. ROSS, LCSW
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 1258 PURDYTOWN TPKE
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City | LAKEVILLE
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State | PA
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Zip | 18438-6793
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Country | US
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Telephone | 302-463-5434
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Fax |
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Provider Business Mailing Address
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Address Line | 1219 HEMLOCK FARMS
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City | HAWLEY
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State | PA
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Zip | 18428-9014
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Country | US
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Telephone | 302-463-5434
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | JEANNE ROSS
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Credential | M.S.W.
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Telephone | 302-463-5434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R018523
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License Number State | NY
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