Healthcare Provider Details

I. General information

NPI: 1851018147
Provider Name (Legal Business Name): POLLY PACCASSI LUND MSW, CSW-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CALLE PORTAL STE 700
SIERRA VISTA AZ
85635-2973
US

IV. Provider business mailing address

1205 N F AVE
DOUGLAS AZ
85607-1920
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-1429
  • Fax: 520-515-8690
Mailing address:
  • Phone: 520-364-1429
  • Fax: 520-515-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12957061-3506
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: