Provider Demographics
NPI:1780759332
Name:ROSS, ROBIN S (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:S
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LAKE COOK RD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5646
Mailing Address - Country:US
Mailing Address - Phone:847-405-0220
Mailing Address - Fax:847-405-0215
Practice Address - Street 1:420 LAKE COOK RD
Practice Address - Street 2:SUITE 113
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5646
Practice Address - Country:US
Practice Address - Phone:847-405-0220
Practice Address - Fax:847-405-0215
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL422-6178OtherAETNA PROVIDER NO
IL04972104OtherBCBS PROVIDER NUMBER
IL056-596OtherVALUE OPTIONS PROVIDER NO
IL055043OtherMAGELLAN PROVIDER NO