MEDICARE: INGRID JONES MANFREDO LCSW-C, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	09922	MD
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCA322	MD

General Provider Information

NPI Number	:	1235572835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID JONES MANFREDO LCSW-C, LCADC

Provider Business Mailing Address
First Line	:	PO BOX 1473
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-0473
Country	:	US
Telephone Number	:	301-639-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 ROSEMONT AVE # 1
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4135
Country	:	US
Telephone Number	:	301-639-1545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	09/25/2025

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