Provider Demographics
NPI:1609840107
Name:ROSS, SUSAN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9530
Mailing Address - Country:US
Mailing Address - Phone:518-869-7830
Mailing Address - Fax:518-869-4265
Practice Address - Street 1:1A PINE WEST PLZ
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5556
Practice Address - Country:US
Practice Address - Phone:518-862-1665
Practice Address - Fax:518-862-1668
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical