Provider Demographics
NPI:1043319767
Name:INGRAHAM, RICHARD L (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:INGRAHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-4640
Mailing Address - Country:US
Mailing Address - Phone:239-213-0557
Mailing Address - Fax:
Practice Address - Street 1:6075 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7454
Practice Address - Country:US
Practice Address - Phone:239-455-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical