Provider Demographics
NPI:1881472710
Name:INGA KORSGAARD LLC
Entity type:Organization
Organization Name:INGA KORSGAARD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:INGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORSGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:347-674-1136
Mailing Address - Street 1:30 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1043
Mailing Address - Country:US
Mailing Address - Phone:347-549-0280
Mailing Address - Fax:
Practice Address - Street 1:145 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2128
Practice Address - Country:US
Practice Address - Phone:347-674-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INGA KORSGAARD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-21
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty