Provider Demographics
NPI:1417014549
Name:ROSS, STEVEN (PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1614
Mailing Address - Country:US
Mailing Address - Phone:925-866-3663
Mailing Address - Fax:
Practice Address - Street 1:2551 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1614
Practice Address - Country:US
Practice Address - Phone:925-866-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11612103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist