Provider Demographics
NPI:1447344106
Name:INGELLIS, ANN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:INGELLIS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 BRENTWOOD ROAD
Mailing Address - Street 2:BRENTWOOD MENTAL HEALTH CLINIC
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-853-7300
Mailing Address - Fax:
Practice Address - Street 1:1841 BRENTWOOD ROAD
Practice Address - Street 2:BRENTWOOD MENTAL HEALTH CLINIC
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-853-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0331051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8C381Medicare ID - Type Unspecified