Provider Demographics
NPI:1689792103
Name:ROSS, RAISA (MSW)
Entity Type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 DUGDALE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5552
Mailing Address - Country:US
Mailing Address - Phone:718-668-1061
Mailing Address - Fax:
Practice Address - Street 1:133 DUGDALE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5552
Practice Address - Country:US
Practice Address - Phone:718-668-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker