Healthcare Provider Details

I. General information

NPI: 1275721722
Provider Name (Legal Business Name): INGRID MURIEL ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 GIDNEY AVE SUITE 2
NEWBURGH NY
12550-2800
US

IV. Provider business mailing address

633 GIDNEY AVE SUITE 2
NEWBURGH NY
12550-2800
US

V. Phone/Fax

Practice location:
  • Phone: 845-569-2900
  • Fax: 845-569-2901
Mailing address:
  • Phone: 845-569-2900
  • Fax: 845-569-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR052278-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: