Provider Demographics
NPI:1487830840
Name:LAUREN M. PELLEGRINI-HUBSTER, LCSW, INC.
Entity Type:Organization
Organization Name:LAUREN M. PELLEGRINI-HUBSTER, LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:PELLEGRINI-HUBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:219-308-8558
Mailing Address - Street 1:101 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2659
Mailing Address - Country:US
Mailing Address - Phone:219-308-8558
Mailing Address - Fax:219-663-3549
Practice Address - Street 1:730 N MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3236
Practice Address - Country:US
Practice Address - Phone:219-308-8558
Practice Address - Fax:219-663-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005273A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN251080Medicare PIN