Provider Demographics
NPI:1982892683
Name:ROSS, JASON ERIC (MSED)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ERIC
Last Name:ROSS
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 S FEDERAL HWY STE 123
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5194
Mailing Address - Country:US
Mailing Address - Phone:561-523-5724
Mailing Address - Fax:
Practice Address - Street 1:1030 S FEDERAL HWY STE 123
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5194
Practice Address - Country:US
Practice Address - Phone:561-523-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 5089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health