Provider Demographics
NPI:1003914052
Name:ROSS, KAREN SUE (MSW IN CALIF LCSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW IN CALIF LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12377 LEWIS ST
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4691
Mailing Address - Country:US
Mailing Address - Phone:714-703-1366
Mailing Address - Fax:714-750-0464
Practice Address - Street 1:12377 LEWIS ST
Practice Address - Street 2:SUITE # 104
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4691
Practice Address - Country:US
Practice Address - Phone:714-703-1366
Practice Address - Fax:714-750-0464
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS7205103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW7205EMedicare ID - Type Unspecified
S31947Medicare UPIN