=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629804257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ROSS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2024
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10730 N ORACLE RD UNIT 21204
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85737-9373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-301-3294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10730 N ORACLE RD UNIT 21204
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85737-9373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-301-3294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 21920
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------