Provider Demographics
NPI:1386804433
Name:ROSS, LISA MARIE (MSW LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:2025 S BRENTWOOD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144
Mailing Address - Country:US
Mailing Address - Phone:314-963-8900
Mailing Address - Fax:314-963-8950
Practice Address - Street 1:2025 S BRENTWOOD
Practice Address - Street 2:SUITE 206
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:314-963-8900
Practice Address - Fax:314-963-8950
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030227441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical