Provider Demographics
NPI:1194806554
Name:DELL-ROSS, PATRICIA JOY (MSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOY
Last Name:DELL-ROSS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 HAVERHILL ST UNIT 213
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1549
Mailing Address - Country:US
Mailing Address - Phone:978-618-7994
Mailing Address - Fax:978-462-3287
Practice Address - Street 1:42 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2606
Practice Address - Country:US
Practice Address - Phone:978-618-7994
Practice Address - Fax:978-462-3287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA01046531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP50031OtherBCBS INDIVIDUAL ID #
MA4212987OtherAETNA ID #
MAP10260OtherBCBS MA GROUP ID #
MA1039062OtherCIGNA ID #
MA684200OtherBEACON HS
MAA021518OtherVALUE OPTIONS ID NUMBER
MA004112OtherVALUE OPTIONS INDIV ID #
MA1014950OtherFALLON ID #
MA1014950OtherFALLON ID #
MA684200OtherBEACON HS
MAP30154Medicare ID - Type UnspecifiedGROUP IDENTIFIER