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General NPI Number Information
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NPI Number | 1689208027
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Entity Type | Individual
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Provider Name | JAKE DYLAN ROSS PSY.D
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Gender | Male
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 351 MANVILLE RD STE 109
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-2166
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Country | US
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Telephone | 914-919-9309
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Fax |
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Provider Business Mailing Address
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Address Line | 45 TIMBER RDG
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City | MOUNT KISCO
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State | NY
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Zip | 10549-3623
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Country | US
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Telephone | 516-816-4931
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 023603
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License Number State | NY
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