Provider Demographics
NPI:1043235369
Name:ROSS, MARIANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 GLENNEYRE ST STE D
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2303
Mailing Address - Country:US
Mailing Address - Phone:949-737-7609
Mailing Address - Fax:949-376-9706
Practice Address - Street 1:380 GLENNEYRE ST STE D
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2303
Practice Address - Country:US
Practice Address - Phone:949-737-7609
Practice Address - Fax:949-376-9706
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8317103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling