Provider Demographics
NPI:1770687097
Name:ROSS, GEORGIA ANTOINETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:ANTOINETTE
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2114
Mailing Address - Country:US
Mailing Address - Phone:724-674-2431
Mailing Address - Fax:724-654-3461
Practice Address - Street 1:507 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-2114
Practice Address - Country:US
Practice Address - Phone:724-674-2431
Practice Address - Fax:724-654-3461
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014088L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR0522762OtherHIGHMARK BLUE SHIELD FEP
PA155830OtherVALUEOPTIONS
PA155830OtherVALUEOPTIONS
PAS59134Medicare UPIN