Provider Demographics
NPI:1699824490
Name:ROSS ISRAEL, FERN LESLIE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:FERN
Middle Name:LESLIE
Last Name:ROSS ISRAEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 GRANITE AVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5625
Mailing Address - Country:US
Mailing Address - Phone:617-698-0991
Mailing Address - Fax:617-696-1274
Practice Address - Street 1:464 GRANITE AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5625
Practice Address - Country:US
Practice Address - Phone:617-698-0991
Practice Address - Fax:617-696-1274
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health