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General NPI Number Information
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NPI Number | 1548451867
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Entity Type | Individual
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Provider Name | RENEE M ROSS LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | PEOPLES ACADEMY 202 COPLEY AVE
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City | MORRISVILLE
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State | VT
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Zip | 05661
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Country | US
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Telephone | 802-888-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 292 STOWEBURY RD
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City | WATERBURY CENTER
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State | VT
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Zip | 05677-7010
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Country | US
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Telephone | 802-244-6145
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0890001145
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License Number State | VT
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