Provider Demographics
NPI:1750695714
Name:MIDDLETON, INGRID MARIA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:INGRID
Middle Name:MARIA
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LOG CANOE CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2127
Mailing Address - Country:US
Mailing Address - Phone:410-604-0226
Mailing Address - Fax:877-643-0126
Practice Address - Street 1:155 LOG CANOE CIR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2127
Practice Address - Country:US
Practice Address - Phone:410-604-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI36361041C0700X
VA09040101551041C0700X
MD233971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical