Provider Demographics
NPI:1093216483
Name:ROSS, LIANA (MHC-LP)
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 STEVENS ST UNIT 53
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2039
Mailing Address - Country:US
Mailing Address - Phone:516-205-9572
Mailing Address - Fax:
Practice Address - Street 1:585 STEWART AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4783
Practice Address - Country:US
Practice Address - Phone:516-280-7285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health