Provider Demographics
NPI:1285741975
Name:HOUT-ROSS, JACQUELYN (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:HOUT-ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:ANN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2215 BURDETT AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH DEPT
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2466
Mailing Address - Country:US
Mailing Address - Phone:518-271-3300
Mailing Address - Fax:
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:BEHAVIORAL HEALTH DEPT
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0700251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical