Provider Demographics
NPI:1093044596
Name:ROSS, REBECCA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 LAFAYETTE ST STE 1209
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3327
Mailing Address - Country:US
Mailing Address - Phone:917-204-7259
Mailing Address - Fax:
Practice Address - Street 1:122 WEST ST
Practice Address - Street 2:APT. 5J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1970
Practice Address - Country:US
Practice Address - Phone:917-204-7259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0804261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical