Susan A Ross, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

008278 Issued in NY

Practice address

1A Pine West PLZ
Albany, NY 12205-5556

Phone

(518) 862-1665

Fax

(518) 862-1668

NPI assigned

Feb 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 7, 2021 through May 7, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pine Bush Mental Health, LLP

  • Clinical Psychologist
  • Albany, NY
  • NPI 1962572362
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214352000000",
    "number": "1609840107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 HIGHGATE DR",
            "city": "SLINGERLANDS",
            "state": "NY",
            "postal_code": "121599530",
            "telephone_number": "518-869-7830",
            "fax_number": "518-869-4265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1A PINE WEST PLZ",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122055556",
            "telephone_number": "518-862-1665",
            "fax_number": "518-862-1668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "SUSAN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-14",
        "last_updated": "2008-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "008278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey William Ross, M.D.
• Juliet L Ross
• Leigh Ross, PSY.D
• Mikaela M Ross, DPT
• Phillip Edward Ross, MD
• David Robert Rossetti, LCSW-R
• Jordan Rossettini, RN, PMHNP
• Elizabeth Sook Rossi
• Nicole Rossi, PA-C
• Samantha M Rossi

• Clinical Psychologist in Albany, NY
• Providers in Albany, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.