Provider Demographics
NPI:1366159584
Name:ROSS, JANIA Y
Entity type:Individual
Prefix:
First Name:JANIA
Middle Name:Y
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 1:56 POQUONOCK AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2507
Mailing Address - Country:US
Mailing Address - Phone:475-261-0459
Mailing Address - Fax:252-484-6046
Practice Address - Street 1:56 POQUONOCK AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2507
Practice Address - Country:US
Practice Address - Phone:475-261-0459
Practice Address - Fax:252-484-6046
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58181041C0700X
CT127191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical