Provider Demographics
NPI:1265693196
Name:WILLGREN, INGRID ELISABETH (MA; LMHC)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:ELISABETH
Last Name:WILLGREN
Suffix:
Gender:F
Credentials:MA; LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 KINNEY ST
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-1016
Mailing Address - Country:US
Mailing Address - Phone:845-398-0359
Mailing Address - Fax:
Practice Address - Street 1:150 S BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4422
Practice Address - Country:US
Practice Address - Phone:845-398-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003390-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health