Provider Demographics
NPI:1447323050
Name:CONKLIN, INGRID ZOOI (LCSW-C)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:ZOOI
Last Name:CONKLIN
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 1:4915 AUBURN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2636
Mailing Address - Country:US
Mailing Address - Phone:301-718-2970
Mailing Address - Fax:301-718-2972
Practice Address - Street 1:4915 AUBURN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2636
Practice Address - Country:US
Practice Address - Phone:301-718-2970
Practice Address - Fax:301-718-2972
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical