Healthcare Provider Details

I. General information

NPI: 1053252536
Provider Name (Legal Business Name): JAILYN LIZETH RECINOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ILLINOIS ST
INDIANAPOLIS IN
46202-1316
US

IV. Provider business mailing address

1700 N ILLINOIS ST
INDIANAPOLIS IN
46202-1316
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-2723
  • Fax:
Mailing address:
  • Phone: 317-554-5700
  • Fax: 317-931-5113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012801A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: