Provider Demographics
NPI:1659909703
Name:ROSS, PETRANELLA LADINE
Entity Type:Individual
Prefix:
First Name:PETRANELLA
Middle Name:LADINE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 BLAKE AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-7417
Mailing Address - Country:US
Mailing Address - Phone:678-629-0216
Mailing Address - Fax:
Practice Address - Street 1:375 BLAKE AVE APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7417
Practice Address - Country:US
Practice Address - Phone:678-629-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103131104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker