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General NPI Number Information
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NPI Number | 1366711855
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Entity Type | Individual
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Provider Name | TERESA JEAN INGRAM LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 3903 PADDLEWHEEL CT
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City | BRANDON
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State | FL
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Zip | 33511-7959
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Country | US
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Telephone | 480-220-8926
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Fax | 802-208-9264
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Provider Business Mailing Address
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Address Line | 3903 PADDLEWHEEL CT
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City | BRANDON
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State | FL
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Zip | 33511-7959
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Country | US
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Telephone | 480-220-8926
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Fax | 802-208-9264
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW16570
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License Number State | FL
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