Provider Demographics
NPI:1124194550
Name:ROUSSEAU, INGRID GEMMA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:GEMMA
Last Name:ROUSSEAU
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MARYANN LN
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-4017
Mailing Address - Country:US
Mailing Address - Phone:516-437-0152
Mailing Address - Fax:516-437-0152
Practice Address - Street 1:508 MARYANN LN
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-4017
Practice Address - Country:US
Practice Address - Phone:516-437-0152
Practice Address - Fax:516-437-0152
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0696481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical