Provider Demographics
NPI:1376191270
Name:WARNER BAGLEY, MADALLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:MADALLYN
Middle Name:
Last Name:WARNER BAGLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MADALLYN
Other - Middle Name:
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:390 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-2300
Mailing Address - Country:US
Mailing Address - Phone:317-779-7574
Mailing Address - Fax:317-215-5766
Practice Address - Street 1:390 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2300
Practice Address - Country:US
Practice Address - Phone:317-779-7574
Practice Address - Fax:317-215-5766
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008629A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical