Provider Demographics
NPI:1679896609
Name:INGRASSIA, TONY (MAC, CIT)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:
Last Name:INGRASSIA
Suffix:
Gender:M
Credentials:MAC, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 BOONES LICK RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2332
Mailing Address - Country:US
Mailing Address - Phone:636-373-0745
Mailing Address - Fax:636-300-1155
Practice Address - Street 1:1521 BOONES LICK RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2332
Practice Address - Country:US
Practice Address - Phone:636-373-0745
Practice Address - Fax:636-300-1155
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor