Provider Demographics
NPI:1972690402
Name:ROSS, CAROLYN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:M
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 1:700 E TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5733
Mailing Address - Country:US
Mailing Address - Phone:610-853-2340
Mailing Address - Fax:610-853-2343
Practice Address - Street 1:700 E TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5733
Practice Address - Country:US
Practice Address - Phone:610-853-2340
Practice Address - Fax:610-853-2343
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014491103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7758293OtherAETNA
PA073179Medicare ID - Type UnspecifiedLCSW