Provider Demographics
NPI:1942512876
Name:ROSS, JUDITH (LCSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 NEW SOUTH ST
Mailing Address - Street 2:116
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4073
Mailing Address - Country:US
Mailing Address - Phone:413-582-0471
Mailing Address - Fax:413-582-1807
Practice Address - Street 1:17 NEW SOUTH ST
Practice Address - Street 2:116
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4073
Practice Address - Country:US
Practice Address - Phone:413-582-0471
Practice Address - Fax:413-582-1807
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA215866104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker