MEDICARE: LAUREN MURPHY PAYNE LCSW

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	0179	WI

General Provider Information

NPI Number	:	1720087364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MURPHY PAYNE LCSW

Provider Business Mailing Address
First Line	:	6021 DURAND AVE
Second Line	:	SUITE 300
City	:	RACINE
State	:	WI
Zip	:	53406-5096
Country	:	US
Telephone Number	:	262-554-0126
Fax Number	:	262-554-0127

Provider Business Practice Location Address
First Line	:	6021 DURAND AVE
Second Line	:	SUITE 300
City	:	RACINE
State	:	WI
Zip	:	53406-5096
Country	:	US
Telephone Number	:	262-554-0126
Fax Number	:	262-554-0127

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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