Provider Demographics
NPI:1982926291
Name:ROSS, JAMIE ANN (MA, PD, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ANN
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, PD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BROOKSITE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3492
Mailing Address - Country:US
Mailing Address - Phone:631-312-7123
Mailing Address - Fax:
Practice Address - Street 1:2 BROOKSITE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3492
Practice Address - Country:US
Practice Address - Phone:631-312-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000789-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist