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General NPI Number Information
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NPI Number | 1912123571
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Entity Type | Individual
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Provider Name | DAVID MICHAEL POLES LMHC, CRC, LADC1
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 736 CAMBRIDGE ST
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City | BRIGHTON
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State | MA
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Zip | 02135-2907
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Country | US
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Telephone | 617-562-5375
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Fax |
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Provider Business Mailing Address
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Address Line | 61 CHURCHILL ST
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City | NEWTON
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State | MA
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Zip | 02460-1443
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Country | US
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Telephone |
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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 | 5667
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License Number State | MA
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