Provider Demographics
NPI:1588714208
Name:ROSS, CAROL L (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LOCKPORT OLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:NY
Mailing Address - Zip Code:14108-9674
Mailing Address - Country:US
Mailing Address - Phone:716-622-2130
Mailing Address - Fax:
Practice Address - Street 1:400 BEWLEY BUILDING
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-2934
Practice Address - Country:US
Practice Address - Phone:716-622-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0579971104100000X
101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000528240001OtherBCBS
NYRA6745Medicare ID - Type Unspecified