Provider Demographics
NPI:1467209379
Name:ROSS, STACEY L (CPRS)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-2246
Mailing Address - Country:US
Mailing Address - Phone:609-610-2944
Mailing Address - Fax:
Practice Address - Street 1:1931 BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4603
Practice Address - Country:US
Practice Address - Phone:609-610-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ581175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist