Provider Demographics
NPI:1487783643
Name:ROSS, RICHARD Z (MHC, PA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:Z
Last Name:ROSS
Suffix:
Gender:M
Credentials:MHC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MAIN ST
Mailing Address - Street 2:#2
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3622
Mailing Address - Country:US
Mailing Address - Phone:914-631-3590
Mailing Address - Fax:914-631-3590
Practice Address - Street 1:96 MAIN ST
Practice Address - Street 2:#2
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3622
Practice Address - Country:US
Practice Address - Phone:914-631-3590
Practice Address - Fax:914-631-3590
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001169 & 000285101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health