Provider Demographics
NPI:1700425626
Name:PERRY, ROSS WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:WILLIAM
Last Name:PERRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:PA
Mailing Address - Zip Code:15779-0111
Mailing Address - Country:US
Mailing Address - Phone:585-474-5021
Mailing Address - Fax:
Practice Address - Street 1:121 LONGVIEW DRIVE
Practice Address - Street 2:STATE ROUTE 1014
Practice Address - City:TORRANCE
Practice Address - State:PA
Practice Address - Zip Code:15779
Practice Address - Country:US
Practice Address - Phone:585-474-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0210051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical