Provider Demographics
NPI:1275604464
Name:ROSS, KERI L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:L
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 1:23560 LYONS AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2521
Mailing Address - Country:US
Mailing Address - Phone:661-287-3751
Mailing Address - Fax:
Practice Address - Street 1:23560 LYONS AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2521
Practice Address - Country:US
Practice Address - Phone:661-287-3751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17660103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY17660OtherLICENSE NUMBER