Provider Demographics
NPI:1033837554
Name:EVANOFF, LAUREN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:EVANOFF
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E COIL ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1169
Mailing Address - Country:US
Mailing Address - Phone:317-531-2650
Mailing Address - Fax:
Practice Address - Street 1:13578 E 131ST ST STE 260
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6401
Practice Address - Country:US
Practice Address - Phone:317-531-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009850A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical