Provider Demographics
NPI:1558444364
Name:INGBER, PAMELA WESLEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:WESLEY
Last Name:INGBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAND MARK DR
Mailing Address - Street 2:APT 199
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-2166
Mailing Address - Country:US
Mailing Address - Phone:845-798-6471
Mailing Address - Fax:
Practice Address - Street 1:11 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1545
Practice Address - Country:US
Practice Address - Phone:845-798-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069523-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187626Medicaid
NYNX 4001Medicare ID - Type Unspecified