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General NPI Number Information
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NPI Number | 1609840107
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Entity Type | Individual
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Provider Name | SUSAN A ROSS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1A PINE WEST PLZ
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City | ALBANY
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State | NY
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Zip | 12205-5556
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Country | US
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Telephone | 518-862-1665
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Fax | 518-862-1668
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Provider Business Mailing Address
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Address Line | 308 HIGHGATE DR
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City | SLINGERLANDS
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State | NY
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Zip | 12159-9530
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Country | US
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Telephone | 518-869-7830
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Fax | 518-869-4265
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 008278
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License Number State | NY
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