Provider Demographics
NPI:1285682807
Name:ROSS, ROLAND E (LCSW)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2011
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-2011
Mailing Address - Country:US
Mailing Address - Phone:970-987-9879
Mailing Address - Fax:970-384-2938
Practice Address - Street 1:817 COLORADO AVE
Practice Address - Street 2:SUITE106
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3349
Practice Address - Country:US
Practice Address - Phone:970-987-9879
Practice Address - Fax:970-384-2938
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9860291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33904049Medicaid
CO804824Medicare UPIN