Provider Demographics
NPI:1154468262
Name:ROSS, BETSY R (LICENSED INDEPENDENT)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COUNTRY LANE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067
Mailing Address - Country:US
Mailing Address - Phone:781-784-0905
Mailing Address - Fax:
Practice Address - Street 1:28 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067
Practice Address - Country:US
Practice Address - Phone:781-784-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07093OtherBCBS
MAP07093OtherBCBS