Provider Demographics
NPI:1831374057
Name:INGRAM-BOSLAU, ADRIENNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:
Last Name:INGRAM-BOSLAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 UNIONVILLE RD STE 175
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3418
Mailing Address - Country:US
Mailing Address - Phone:724-776-3366
Mailing Address - Fax:
Practice Address - Street 1:3104 UNIONVILLE RD STE 175
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-776-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016364103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist