Provider Demographics
NPI:1063598365
Name:ROSS, JANE H (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:H
Last Name:ROSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:472 FEARRINGTON POST
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8500
Mailing Address - Country:US
Mailing Address - Phone:919-542-3210
Mailing Address - Fax:919-401-6610
Practice Address - Street 1:3622 LYCKAN PKWY
Practice Address - Street 2:SUITE 4003
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2564
Practice Address - Country:US
Practice Address - Phone:919-490-8473
Practice Address - Fax:919-401-6610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0445WOtherBCBS PSYCHOLOGIST
NC6000300Medicaid
NC0445WOtherBCBS PSYCHOLOGIST