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General NPI Number Information
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NPI Number | 1306495361
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Entity Type | Individual
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Provider Name | DESIREE POLONIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 10178 SWEETGRASS CIR
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City | NAPLES
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State | FL
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Zip | 34104-0934
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Country | US
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Telephone | 239-398-4972
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Fax |
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Provider Business Mailing Address
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Address Line | 10178 SWEETGRASS CIR
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City | NAPLES
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State | FL
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Zip | 34104-0934
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Country | US
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Telephone | 239-398-4972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 117527
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09932430
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22446
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License Number State | FL
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