1558347385 NPI number — MS. SYLVIA IRENE INGERSON PMH-N, CNS

Table of content: MS. SYLVIA IRENE INGERSON PMH-N, CNS (NPI 1558347385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558347385 NPI number — MS. SYLVIA IRENE INGERSON PMH-N, CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGERSON
Provider First Name:
SYLVIA
Provider Middle Name:
IRENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PMH-N, CNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEVASSEUR
Provider Other First Name:
SYLVIA
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PMH NP CNS LADC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558347385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 TITCOMB HILL RD 4B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04938-5639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-778-1862
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 TITCOMB HILL RD
Provider Second Line Business Practice Location Address:
UNIT B4
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04938-5639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-288-8604
Provider Business Practice Location Address Fax Number:
207-288-8602
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  CNP81144 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: RO14261 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SP0809X , with the licence number: RO14261 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0NS8053 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2082154 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 432710499 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68944BS . This is a "BLUE SHIELD OF VT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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