Provider Demographics
NPI:1932265980
Name:ROSS, BARRY CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:CHARLES
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CORPORATE PARK
Mailing Address - Street 2:SUITE 235
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5107
Mailing Address - Country:US
Mailing Address - Phone:949-852-1410
Mailing Address - Fax:949-852-0220
Practice Address - Street 1:7 CORPORATE PARK
Practice Address - Street 2:SUITE 235
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5107
Practice Address - Country:US
Practice Address - Phone:949-852-1410
Practice Address - Fax:949-852-0220
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP8592Medicare ID - Type Unspecified