Provider Demographics
NPI:1093886871
Name:EINSTEIN, INGRID B (LICSW)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:B
Last Name:EINSTEIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1512
Mailing Address - Country:US
Mailing Address - Phone:781-784-1177
Mailing Address - Fax:781-784-8440
Practice Address - Street 1:6 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1512
Practice Address - Country:US
Practice Address - Phone:781-784-1177
Practice Address - Fax:781-784-8440
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10206071041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA004336OtherHARVARD PILGRIM
MA5363523OtherAETNA
MAP06089OtherBCBS
MA5363523OtherAETNA