Provider Demographics
NPI:1639418833
Name:ROSS, PATTY (LCSW)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11760 W SAMPLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3199
Mailing Address - Country:US
Mailing Address - Phone:954-345-5644
Mailing Address - Fax:954-345-5683
Practice Address - Street 1:11760 W SAMPLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3199
Practice Address - Country:US
Practice Address - Phone:954-345-5644
Practice Address - Fax:954-345-5683
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW9795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health