Provider Demographics
NPI:1073144929
Name:JAIPERSAUD, INGRID DENISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:DENISE
Last Name:JAIPERSAUD
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 1:9131 QUEENS BLVD STE 611
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5543
Mailing Address - Country:US
Mailing Address - Phone:718-454-2222
Mailing Address - Fax:718-264-0257
Practice Address - Street 1:9131 QUEENS BLVD STE 611
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5543
Practice Address - Country:US
Practice Address - Phone:718-454-2222
Practice Address - Fax:718-264-0257
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023658103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty