Provider Demographics
NPI:1891019170
Name:ROSS, NOVELETT
Entity Type:Individual
Prefix:
First Name:NOVELETT
Middle Name:
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 1:117-27 193RD STREET
Mailing Address - Street 2:
Mailing Address - City:ST. ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412
Mailing Address - Country:US
Mailing Address - Phone:718-749-2478
Mailing Address - Fax:
Practice Address - Street 1:2581 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2412
Practice Address - Country:US
Practice Address - Phone:718-385-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07072211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical