Provider Demographics
NPI:1063012318
Name:KORSGAARD, INGA (PHD)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:KORSGAARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1043
Mailing Address - Country:US
Mailing Address - Phone:347-549-0280
Mailing Address - Fax:
Practice Address - Street 1:30 JOHN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1043
Practice Address - Country:US
Practice Address - Phone:347-549-0280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4204103T00000X
RIPS01914103T00000X
NY023947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023947OtherNYS STATE LICENSE NUMBER
18001OtherPSYPACT APIT
RIPS01914OtherRHODE ISLAND LICENSE NUMBER
CT4204OtherCONNECTICUT LICENSE NUMBER