Provider Demographics
NPI:1659303378
Name:ROSS, DEBORAH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
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 1:1450 SOM CENTER RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2118
Mailing Address - Country:US
Mailing Address - Phone:440-460-1500
Mailing Address - Fax:
Practice Address - Street 1:1450 SOM CENTER RD
Practice Address - Street 2:SUITE 22
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2118
Practice Address - Country:US
Practice Address - Phone:440-460-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0608088Medicaid
OH000000146378OtherANTHEM
OH021229000OtherMAGELLAN
OHCP09871Medicare PIN