Provider Demographics
NPI:1730310269
Name:ROSS, DOROTHY CRYSTAL
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:CRYSTAL
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 1:525 WEST END AVENUE
Mailing Address - Street 2:APT 9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3207
Mailing Address - Country:US
Mailing Address - Phone:212-496-7375
Mailing Address - Fax:
Practice Address - Street 1:525 WEST END AVENUE
Practice Address - Street 2:APT 9C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3207
Practice Address - Country:US
Practice Address - Phone:212-496-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYSI.D.00761102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst