Provider Demographics
NPI:1083072714
Name:ROSS, STACY ROSS (MSW)
Entity Type:Individual
Prefix:
First Name:STACY ROSS
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 E CENTRAL ST
Mailing Address - Street 2:201A
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3644
Mailing Address - Country:US
Mailing Address - Phone:508-647-1644
Mailing Address - Fax:508-809-7467
Practice Address - Street 1:154 E CENTRAL ST
Practice Address - Street 2:201A
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3644
Practice Address - Country:US
Practice Address - Phone:508-647-1644
Practice Address - Fax:508-809-7467
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10237811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical