Provider Demographics
NPI:1750865739
Name:INGRAO, VERONICA (LCSW, LICSWLADC, CCS)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:INGRAO
Suffix:
Gender:F
Credentials:LCSW, LICSWLADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4869
Mailing Address - Country:US
Mailing Address - Phone:207-560-5758
Mailing Address - Fax:
Practice Address - Street 1:22 HAWTHORNE ST # 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5410
Practice Address - Country:US
Practice Address - Phone:781-296-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7015101YA0400X
MA123730101YM0800X
MELC19444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)