Provider Demographics
NPI:1932317245
Name:ROSS, CARMEL T (MFT)
Entity Type:Individual
Prefix:MS
First Name:CARMEL
Middle Name:T
Last Name:ROSS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 SEAGRAMS CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3532
Mailing Address - Country:US
Mailing Address - Phone:510-909-4712
Mailing Address - Fax:775-295-7110
Practice Address - Street 1:20200 REDWOOD RD
Practice Address - Street 2:SUITE #6
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4312
Practice Address - Country:US
Practice Address - Phone:510-909-4712
Practice Address - Fax:775-295-7110
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43438106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist