Active NPI
Marissa Ross
- Mental Health Counselor
- Fairport, NY
National Provider Identifier
1609240654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 006179
- Practice address
- 1387 Fairport Rd
Fairport, NY 14450-2003 - Phone
- (585) 310-0425
- NPI assigned
- Nov 13, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 006179 | NY | Primary |
Addresses
Primary practice location
1387 Fairport Rd
Fairport, NY 14450-2003
Mailing address
1387 Fairport Road
Building 500
Fairport, NY 14450
Phone (585) 310-0425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Mar 26, 2024 through Mar 26, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006179 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458172800000",
"number": "1609240654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1387 FAIRPORT ROAD",
"address_2": "BUILDING 500",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "14450",
"telephone_number": "585-310-0425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1387 FAIRPORT RD",
"city": "FAIRPORT",
"state": "NY",
"postal_code": "144502003",
"telephone_number": "585-310-0425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSS",
"first_name": "MARISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-13",
"last_updated": "2016-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "006179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.