Provider Demographics
NPI:1659452423
Name:INGRAHAM, NANCY ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELLEN
Last Name:INGRAHAM
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 1:4701 WILLARD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4607
Mailing Address - Country:US
Mailing Address - Phone:202-491-1376
Mailing Address - Fax:301-656-3437
Practice Address - Street 1:4701 WILLARD AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4607
Practice Address - Country:US
Practice Address - Phone:202-491-1376
Practice Address - Fax:301-656-3437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003380103T00000X
MD04616103TC0700X
DCPSY100330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical