Provider Demographics
NPI:1134834369
Name:ROSS, ANGELA ARNOLD (MS, LCGC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ARNOLD
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:G
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LCGC
Mailing Address - Street 1:3 CARLOUGH RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1803
Mailing Address - Country:US
Mailing Address - Phone:646-934-0675
Mailing Address - Fax:
Practice Address - Street 1:3 CARLOUGH RD
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-1803
Practice Address - Country:US
Practice Address - Phone:646-934-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MJ00029500170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MJ00029500OtherGENETIC COUNSELING ADVISORY COMMITTEE LICENCE