Basic Information
| Provider Information | |||||||||
| NPI: | 1093076994 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | ROSS | ||||||||
| OtherFirstName: | PAUL | ||||||||
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| OtherCredential: | LICSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 96 SOUTH ST | ||||||||
| Address2: | |||||||||
| City: | WARE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010821616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4139676241 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 96 N PLEASANT ST STE 303 | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010021717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4133184772 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2012 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 120331 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.