Provider Demographics
NPI:1124262654
Name:INGULLI, LAMAR J (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAMAR
Middle Name:J
Last Name:INGULLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 W SWANN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4050
Mailing Address - Country:US
Mailing Address - Phone:813-381-5200
Mailing Address - Fax:813-381-5200
Practice Address - Street 1:2919 W SWANN AVE STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4050
Practice Address - Country:US
Practice Address - Phone:813-381-5200
Practice Address - Fax:813-381-5200
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8120103G00000X
103T00000X
FLPY8120103T00000X, 103TC2200X, 103TF0200X, 103TM1800X, 103G00000X
FL8120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007293800Medicaid
FL020601000Medicaid