Provider Demographics
NPI:1508899733
Name:INGATE, MARY RANDALL (LCSW-C)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:RANDALL
Last Name:INGATE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 W CEDAR LN
Mailing Address - Street 2:STE 208B
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1523
Mailing Address - Country:US
Mailing Address - Phone:240-777-1384
Mailing Address - Fax:240-777-3226
Practice Address - Street 1:5415 W CEDAR LN
Practice Address - Street 2:STE 208B
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1523
Practice Address - Country:US
Practice Address - Phone:240-888-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD064451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical