MEDICARE: REGINA CONGROVE 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	33010360A	IN

General Provider Information

NPI Number	:	1699641068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA CONGROVE LCSW

Provider Business Mailing Address
First Line	:	9615 E 148TH ST STE 1
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-4371
Country	:	US
Telephone Number	:	317-574-1254
Fax Number	:	317-674-0060

Provider Business Practice Location Address
First Line	:	2506 WILLOWBROOK PKWY STE 111
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1542
Country	:	US
Telephone Number	:	317-574-1254
Fax Number	:	317-674-0060

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

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	12/09/2025

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