Provider Demographics
NPI:1710907779
Name:INGRAM, KIMBERLY JOYCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JOYCE
Last Name:INGRAM
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 1:663 EMERSON DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1239
Mailing Address - Country:US
Mailing Address - Phone:716-862-8796
Mailing Address - Fax:
Practice Address - Street 1:VA HOSPITAL PCG2
Practice Address - Street 2:3495 BAILEY AVE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-862-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074161-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical