Provider Demographics
NPI:1366506545
Name:ROSS, EILEEN (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PATTEN HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034
Mailing Address - Country:US
Mailing Address - Phone:603-483-5105
Mailing Address - Fax:603-483-0855
Practice Address - Street 1:132 PATTEN HILL RD
Practice Address - Street 2:
Practice Address - City:CANDIA
Practice Address - State:NH
Practice Address - Zip Code:03034-2543
Practice Address - Country:US
Practice Address - Phone:603-483-5105
Practice Address - Fax:603-483-0855
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007157Medicaid