Provider Demographics
NPI:1336237270
Name:TABISEL, ROSS LYNN (LCSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:LYNN
Last Name:TABISEL
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SUNNYSIDE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1517
Mailing Address - Country:US
Mailing Address - Phone:516-576-1118
Mailing Address - Fax:516-576-8876
Practice Address - Street 1:54 SUNNYSIDE BLVD STE A
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1517
Practice Address - Country:US
Practice Address - Phone:516-576-1118
Practice Address - Fax:516-576-8876
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013521-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9G311Medicare ID - Type UnspecifiedSOCIAL WORK