Basic Information
| Provider Information | |||||||||
| NPI: | 1063652048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSS | ||||||||
| FirstName: | LOIS | ||||||||
| MiddleName: | KRIEGER | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 LOCUST AVE | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121805126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182815142 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 435 FOURTH STREET | ||||||||
| Address2: | UNITY SUNSHINE | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182743234 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2009 | ||||||||
| LastUpdateDate: | 03/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 033548-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.