Provider Demographics
NPI:1538973482
Name:INGRAM, OZZIE III (RBT)
Entity type:Individual
Prefix:MR
First Name:OZZIE
Middle Name:
Last Name:INGRAM
Suffix:III
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FOXTAIL LN
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2007
Mailing Address - Country:US
Mailing Address - Phone:609-757-7473
Mailing Address - Fax:
Practice Address - Street 1:7 BENSON ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-9772
Practice Address - Country:US
Practice Address - Phone:609-757-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-24-371744106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician