MEDICARE: INGRID M BRUMMET, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1790485373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGRID M BRUMMET, LLC

Provider Business Mailing Address
First Line	:	1 KALISA WAY STE 101
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3508
Country	:	US
Telephone Number	:	888-948-6789
Fax Number	:	877-345-3501

Provider Business Practice Location Address
First Line	:	4880 ZIEGLER RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-9007
Country	:	US
Telephone Number	:	888-948-6789
Fax Number	:	877-345-3501

Authorized Official
Title or Position	:	LCSW
Name	:	INGRID M BRUMMET
Credential	:	MSW
Telephone Number	:	970-443-3450

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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