Provider Demographics
NPI:1801617352
Name:ROSS, DANIELLE M (PHD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:ROSS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ROSS
Other - Last Name:PIETRALCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:JERMYN
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1305
Mailing Address - Country:US
Mailing Address - Phone:570-335-7350
Mailing Address - Fax:
Practice Address - Street 1:4101 BIRNEY AVE
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1323
Practice Address - Country:US
Practice Address - Phone:570-961-3361
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
PAPS020283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent