Provider Demographics
NPI:1033633219
Name:ROSS, HALEY SHAE (LCSW)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:SHAE
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:SHAE
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-757-0717
Mailing Address - Fax:859-331-2425
Practice Address - Street 1:20 WEST 18TH STREET
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-3329
Practice Address - Country:US
Practice Address - Phone:859-757-0717
Practice Address - Fax:859-331-2425
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252654104100000X
KY2546211041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid