Provider Demographics
NPI:1225123870
Name:ROSS, ELLEN B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:B
Last Name:ROSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6692 CANOGA ROAD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-8087
Mailing Address - Country:US
Mailing Address - Phone:315-255-0089
Mailing Address - Fax:
Practice Address - Street 1:157 GENESEE STREET
Practice Address - Street 2:BASEMENT
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3461
Practice Address - Country:US
Practice Address - Phone:315-253-0341
Practice Address - Fax:315-253-1129
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst