Provider Demographics
NPI:1518004530
Name:INGEMI, GLORIANN (PSYD)
Entity Type:Individual
Prefix:MS
First Name:GLORIANN
Middle Name:
Last Name:INGEMI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 5996
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9063
Mailing Address - Country:US
Mailing Address - Phone:787-239-0737
Mailing Address - Fax:
Practice Address - Street 1:54 CALLE ROBLES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3002
Practice Address - Country:US
Practice Address - Phone:787-239-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004551103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical