Provider Demographics
NPI:1770668865
Name:GRINGLAS, MARCY B (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:B
Last Name:GRINGLAS
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:NEMOURS CHILDRENS CLINIC
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:DUPONT AT JEFFERSON-CHESTNUT
Practice Address - Street 2:1015 CHESTNUT STREET SUITE 601
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4306
Practice Address - Country:US
Practice Address - Phone:215-503-2664
Practice Address - Fax:215-923-0459
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS008200L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7541031Medicaid
NJ116785Medicaid
PA1808301Medicaid
NJ116785Medicaid
043059SAJMedicare PIN