Provider Demographics
NPI:1114230703
Name:PONCIANO, INGRID FAVIOLA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:FAVIOLA
Last Name:PONCIANO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:INGRID
Other - Middle Name:FAVIOLA
Other - Last Name:CARTAGENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:16031 COMPRINT CIR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1320
Mailing Address - Country:US
Mailing Address - Phone:240-489-1108
Mailing Address - Fax:301-407-0657
Practice Address - Street 1:16031 COMPRINT CIR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1320
Practice Address - Country:US
Practice Address - Phone:240-489-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM637101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health