Tina Marie Ingram, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150.106990 Issued in IL

Practice address

631 N Longwood St Ste 103
Rockford, IL 61107-4263

Phone

(815) 962-5585

NPI assigned

Apr 25, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Counseling Services of Northern Illinois

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1639241748
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1437893500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 N LONGWOOD ST STE 103",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074263",
            "telephone_number": "815-962-5585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 N LONGWOOD ST STE 103",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074263",
            "telephone_number": "815-962-5585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "TINA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.106990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Imagine More Counseling Solutions LLC
• Imler Vision Centers, LLC
• In Home Medical Group LLC
• Alexandra Incandela, DPM
• Giovanni Incandela, DPM
• Theodore S. Ingrassia III, M.D.
• Melissa L. Inman, APN
• Innovamed Internal Medicine Specialists SC
• Innovamed Veins SC
• Institute of Family Care

• Social Worker in Rockford, IL
• Providers in Rockford, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.