Provider Demographics
NPI:1073841193
Name:ROSS, JANICE (CASAC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASAC
Mailing Address - Street 1:79 GLENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4523
Mailing Address - Country:US
Mailing Address - Phone:518-952-8408
Mailing Address - Fax:518-399-6860
Practice Address - Street 1:556 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1105
Practice Address - Country:US
Practice Address - Phone:585-442-8422
Practice Address - Fax:585-442-8494
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid