Inga Korsgaard, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

023947 Issued in NY

Practice address

30 John St
Providence, RI 02906-1043

Phone

(347) 549-0280

NPI assigned

Oct 27, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 4

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Inga Korsgaard LLC

  dba Mellem Clinic

  • Mental Health Counselor
  • Providence, RI
  • NPI 1881472710
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1063012318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 JOHN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029061043",
            "telephone_number": "347-549-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 JOHN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029061043",
            "telephone_number": "347-549-0280"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "145 Waterman St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029062128",
            "country_code": "US",
            "telephone_number": "347-549-0280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "192 E 8th St Apt 1A",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112183346",
            "country_code": "US",
            "telephone_number": "347-549-0280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KORSGAARD",
        "first_name": "INGA",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2024-03-25",
        "certification_date": "2023-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CT",
            "license": "4204",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "RI",
            "license": "PS01914",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "023947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS STATE LICENSE NUMBER",
            "identifier": "023947",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYPACT APIT",
            "identifier": "18001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHODE ISLAND LICENSE NUMBER",
            "identifier": "PS01914",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICUT LICENSE NUMBER",
            "identifier": "4204",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.simplepractice.com",
            "affiliation": "N",
            "endpointDescription": "Online secure platform",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "30 John St",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029061043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Kopp, MD
• Nicole Korbly, MD
• Gideon Koren, M.D.
• Elisabeth Kornblee, LICSW
• Kenneth S Korr, MD
• Laura Elizabeth Korthauer Gilmour, PHD
• Molyneat Kosal
• Chirene Kosseifi
• Stefan G Kostadinov, MD
• Michael Philip Koster, M.D.

• Psychologist in Providence, RI
• Providers in Providence, RI by specialty
• Psychologist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.