Provider Demographics
NPI:1427702554
Name:POLLY, LAUREN (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:POLLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:OUTWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:204 BEVINS LN STE A
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6145
Mailing Address - Country:US
Mailing Address - Phone:859-951-9777
Mailing Address - Fax:859-951-9779
Practice Address - Street 1:204 BEVINS LN STE A
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6145
Practice Address - Country:US
Practice Address - Phone:859-951-9777
Practice Address - Fax:859-951-9779
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2576071041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid