Provider Demographics
NPI:1477605236
Name:ROSS, JOLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10436 PARK TREE PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4487
Mailing Address - Country:US
Mailing Address - Phone:781-444-9115
Mailing Address - Fax:
Practice Address - Street 1:140 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2730
Practice Address - Country:US
Practice Address - Phone:781-444-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3976103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70020000W03950OtherBCBS PROVIDER #
MA70020000W03950OtherBCBS PROVIDER #