MEDICARE: LAUREN REGAN MSW, LSW

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	104100000X	Social Worker	33007354A	IN

General Provider Information

NPI Number	:	1588033864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN REGAN MSW, LSW

Provider Business Mailing Address
First Line	:	2115 CENTRAL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 CENTRAL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1636
Country	:	US
Telephone Number	:	317-790-5536
Fax Number	:

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

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	09/17/2015

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