Provider Demographics
NPI:1326163791
Name:INGRAM, SHIRLEY DENISE (ASW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:DENISE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A.B AND JESSIE POLINSKY CHILDREN'S CENTER
Mailing Address - Street 2:9400 RUFFIN COURT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:859-514-9400
Mailing Address - Fax:
Practice Address - Street 1:A.B AND JESSIE POLINSKY CHILDREN'S CENTER
Practice Address - Street 2:9400 RUFFIN COURT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:859-514-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical