Provider Demographics
NPI:1518048925
Name:ROSS, BETH H (LICSW)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:H
Last Name:ROSS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021
Mailing Address - Country:US
Mailing Address - Phone:781-821-4606
Mailing Address - Fax:781-821-4606
Practice Address - Street 1:886 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:781-821-4606
Practice Address - Fax:781-821-4606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10193651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA414301OtherPACIFICARE
MAPO5686OtherBLUE CROSS/BLUE SHIELD
MO461320000OtherMEGELLAN
MAROPO5686Medicare ID - Type UnspecifiedMEDICARE NUMBER