Provider Demographics
NPI:1033277454
Name:ROSS, DOROTHY R (MA,MFT)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10434 JELLICO AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6007
Mailing Address - Country:US
Mailing Address - Phone:818-368-1306
Mailing Address - Fax:818-368-4756
Practice Address - Street 1:10434 JELLICO AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6007
Practice Address - Country:US
Practice Address - Phone:818-368-1306
Practice Address - Fax:818-368-4756
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist