Healthcare Provider Details

I. General information

NPI: 1134760044
Provider Name (Legal Business Name): LAUREN SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13578 E 131ST ST STE 260
FISHERS IN
46037-6401
US

IV. Provider business mailing address

13578 E 131ST ST STE 260
FISHERS IN
46037-6401
US

V. Phone/Fax

Practice location:
  • Phone: 317-827-7870
  • Fax:
Mailing address:
  • Phone: 317-827-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010649A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: