| 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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