Provider Demographics
NPI:1477965416
Name:JEANNETTE D ROSS
Entity Type:Organization
Organization Name:JEANNETTE D ROSS
Other - Org Name:JEAN ROSS, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-223-0105
Mailing Address - Street 1:1730 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-6424
Mailing Address - Country:US
Mailing Address - Phone:941-475-9859
Mailing Address - Fax:941-681-2663
Practice Address - Street 1:1460 S MCCALL RD STE 3H
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4870
Practice Address - Country:US
Practice Address - Phone:941-223-0105
Practice Address - Fax:941-681-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW21471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2818Medicare PIN