Provider Demographics
NPI:1649891474
Name:ROSS, PHILICIA R (LCSW-C)
Entity type:Individual
Prefix:
First Name:PHILICIA
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 GREENMOUNT AVE STE 300
Mailing Address - Street 2:PMB 115148
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6907
Mailing Address - Country:US
Mailing Address - Phone:760-877-1673
Mailing Address - Fax:
Practice Address - Street 1:3030 GREENMOUNT AVE STE 300
Practice Address - Street 2:PMB 115148
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6907
Practice Address - Country:US
Practice Address - Phone:240-712-4106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD257861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty