Provider Demographics
NPI:1104483874
Name:ROSS, CHARLENE L
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PLYMOUTH DR APT 1D
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5473
Mailing Address - Country:US
Mailing Address - Phone:617-898-7030
Mailing Address - Fax:781-688-8159
Practice Address - Street 1:695 TRUMAN HWY
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3552
Practice Address - Country:US
Practice Address - Phone:617-898-7030
Practice Address - Fax:781-688-8159
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health