Provider Demographics
NPI:1235572835
Name:MANFREDO, INGRID JONES (LCSW-C, LCADC)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:JONES
Last Name:MANFREDO
Suffix:
Gender:F
Credentials:LCSW-C, LCADC
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:JONES
Other - Last Name:MANFREDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1473
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0473
Mailing Address - Country:US
Mailing Address - Phone:301-639-1545
Mailing Address - Fax:
Practice Address - Street 1:198 THOMAS JOHNSON DR STE 9
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4443
Practice Address - Country:US
Practice Address - Phone:301-639-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA322101YA0400X
MD099221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)