Provider Demographics
NPI:1245695303
Name:ROSS, BRIEANNE (LMHC)
Entity type:Individual
Prefix:
First Name:BRIEANNE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 E FULTON ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-3212
Mailing Address - Country:US
Mailing Address - Phone:518-773-3531
Mailing Address - Fax:518-773-9103
Practice Address - Street 1:57 E FULTON ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-3212
Practice Address - Country:US
Practice Address - Phone:518-773-3531
Practice Address - Fax:518-773-9103
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006901-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health