Provider Demographics
NPI:1265688840
Name:ROSS, BETTY J (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:J
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5018
Mailing Address - Country:US
Mailing Address - Phone:718-389-5100
Mailing Address - Fax:718-752-4809
Practice Address - Street 1:2215 43RD AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5018
Practice Address - Country:US
Practice Address - Phone:718-389-5100
Practice Address - Fax:718-752-4809
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0526491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03676033Medicaid