| Phyllis Friedman Ross, Licsw, Inc | |
|
76 Gordon Rd Waban MA 02468-1219 | |
| (617) 285-8639 | |
| Not Available |
| Full Name | Phyllis Friedman Ross, Licsw, Inc |
|---|---|
| Speciality | Social Worker |
| Location | 76 Gordon Rd, Waban, Massachusetts |
| Authorized Official Name and Position | Phyllis Friedman Ross (PRESIDENT) |
| Authorized Official Contact | 6172858639 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phyllis Friedman Ross, Licsw, Inc 76 Gordon Rd Waban MA 02468-1219 Ph: (617) 285-8639 | Phyllis Friedman Ross, Licsw, Inc 76 Gordon Rd Waban MA 02468-1219 Ph: (617) 285-8639 |
| NPI Number | 1184381089 |
|---|---|
| Provider Enumeration Date | 11/26/2021 |
| Last Update Date | 11/26/2021 |
| Certification Date | 11/26/2021 |
| Medicare PECOS PAC ID | 2860883329 |
|---|---|
| Medicare Enrollment ID | O20211217000865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184381089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Phyllis Ross |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497849079 PECOS PAC ID: 7214185024 Enrollment ID: I20120920000460 |
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