Provider Demographics
NPI:1497397434
Name:ROSS, ANDREA JENELLE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JENELLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FERN LN
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-9625
Mailing Address - Country:US
Mailing Address - Phone:609-567-6063
Mailing Address - Fax:609-567-6071
Practice Address - Street 1:44 FERN LN
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9625
Practice Address - Country:US
Practice Address - Phone:609-567-6063
Practice Address - Fax:609-567-6071
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health