Provider Demographics
NPI:1710617691
Name:ROSS, SUZANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
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 1:100 OVERLOOK TERR. #819
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3862
Mailing Address - Country:US
Mailing Address - Phone:917-584-2135
Mailing Address - Fax:212-927-2924
Practice Address - Street 1:100 OVERLOOK TERR.
Practice Address - Street 2:APT. 819
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3862
Practice Address - Country:US
Practice Address - Phone:917-584-2135
Practice Address - Fax:212-927-2924
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3749103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist