Provider Demographics
NPI:1104924729
Name:INGROFF, DANIEL WAYNE (LISW LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WAYNE
Last Name:INGROFF
Suffix:
Gender:M
Credentials:LISW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3107
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-758-4882
Mailing Address - Fax:505-737-5844
Practice Address - Street 1:705 FELICIDAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-737-9348
Practice Address - Fax:505-737-5844
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 21491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM100037 VNMOtherVALVEOPTIONS
NM99862Medicaid
NMVNM00686OtherVALUE OPTIONS