Provider Demographics
NPI:1790995298
Name:ROSS, TERRI LYNN (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LYNN
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:MD
Mailing Address - Zip Code:21660-1924
Mailing Address - Country:US
Mailing Address - Phone:410-634-1993
Mailing Address - Fax:410-822-4255
Practice Address - Street 1:406 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:RIDGELY
Practice Address - State:MD
Practice Address - Zip Code:21660-1924
Practice Address - Country:US
Practice Address - Phone:410-634-1993
Practice Address - Fax:410-822-4255
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7170911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical