Individual
GREGORY INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
120 HALCYON PL, ROSELLE, NJ 07203-1512
(908) 422-5340
Mailing address
210 E 2ND AVE, ROSELLE, NJ 07203-1306
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05532900
NJ
1041S0200X
School Social Worker
00273388
NJ
Other
Enumeration date
11/21/2013
Last updated
11/21/2013
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