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General NPI Number Information
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NPI Number | 1750865739
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Entity Type | Individual
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Provider Name | VERONICA INGRAO LCSW, LICSWLADC, CCS
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Gender | Female
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Dates
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Enumeration Date | 09/17/2018
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 22 HAWTHORNE ST # 2
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City | PORTLAND
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State | ME
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Zip | 04103-5410
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Country | US
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Telephone | 781-296-9309
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Fax |
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Provider Business Mailing Address
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Address Line | 25 MIDDLE ST
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City | PORTLAND
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State | ME
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Zip | 04101-4869
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Country | US
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Telephone | 207-560-5758
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LC7015
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 123730
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC19444
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License Number State | ME
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