Provider Demographics
NPI:1578899522
Name:ROSS, JENNIFER HEATHER (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HEATHER
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 BERRY AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2317
Mailing Address - Country:US
Mailing Address - Phone:215-284-0162
Mailing Address - Fax:
Practice Address - Street 1:319 VINE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-1122
Practice Address - Country:US
Practice Address - Phone:215-284-0162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional