1265836902 NPI number — MS. SHEIKETHA ROSS LPC

Table of content: MS. SHEIKETHA ROSS LPC (NPI 1265836902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265836902 NPI number — MS. SHEIKETHA ROSS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
SHEIKETHA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265836902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 HAZEL TERRACE
Provider Second Line Business Mailing Address:
SUITE 23
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06525-5991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-819-7650
Provider Business Mailing Address Fax Number:
203-298-9487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 E RAMSDELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06515-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-781-4600
Provider Business Practice Location Address Fax Number:
203-781-4624
Provider Enumeration Date:
10/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  2622 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 008056047 . This is a "ROSS MEDICAID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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