Provider Demographics
NPI:1184381089
Name:PHYLLIS FRIEDMAN ROSS, LICSW, INC
Entity type:Organization
Organization Name:PHYLLIS FRIEDMAN ROSS, LICSW, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:FRIEDMAN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-285-8639
Mailing Address - Street 1:76 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1219
Mailing Address - Country:US
Mailing Address - Phone:617-285-8639
Mailing Address - Fax:
Practice Address - Street 1:76 GORDON RD
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1219
Practice Address - Country:US
Practice Address - Phone:617-285-8639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty