Provider Demographics
NPI:1801849583
Name:INGERSOLL, JOEL B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:B
Last Name:INGERSOLL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:542 GOEPP CIR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-4315
Mailing Address - Country:US
Mailing Address - Phone:610-865-4830
Mailing Address - Fax:610-865-4830
Practice Address - Street 1:227 W BROAD ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5570
Practice Address - Country:US
Practice Address - Phone:610-865-4830
Practice Address - Fax:610-865-4850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical