Provider Demographics
NPI:1295575512
Name:ROSS, MATTHEW MARKS (MSW, LCSWA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MARKS
Last Name:ROSS
Suffix:
Gender:M
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7417 LONGSTREET DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-7616
Mailing Address - Country:US
Mailing Address - Phone:914-329-5636
Mailing Address - Fax:
Practice Address - Street 1:3710 UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6204
Practice Address - Country:US
Practice Address - Phone:919-906-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0202701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical