Provider Demographics
NPI:1881834422
Name:ROSS, BERLE ELLEN (MA)
Entity type:Individual
Prefix:MS
First Name:BERLE
Middle Name:ELLEN
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BERLE
Other - Middle Name:ROSS
Other - Last Name:WHITBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:120 N BETHLEHEM PIKE
Mailing Address - Street 2:#B104
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1216
Mailing Address - Country:US
Mailing Address - Phone:215-392-0500
Mailing Address - Fax:
Practice Address - Street 1:120 N BETHLEHEM PIKE
Practice Address - Street 2:#B104
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1216
Practice Address - Country:US
Practice Address - Phone:215-392-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health