Provider Demographics
NPI:1609357110
Name:ROSS, MARYNA
Entity Type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYNA
Other - Middle Name:
Other - Last Name:KARAYCHEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1455 DIXON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8880
Mailing Address - Country:US
Mailing Address - Phone:303-443-8500
Mailing Address - Fax:
Practice Address - Street 1:3180 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2208
Practice Address - Country:US
Practice Address - Phone:303-413-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health