MEDICARE: MS. DESIREE POLONIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	117527	CA
2	1041C0700X	Clinical Social Worker	09932430	CO
3	1041C0700X	Clinical Social Worker	22446	FL

General Provider Information

NPI Number	:	1306495361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DESIREE POLONIS LCSW

Provider Business Mailing Address
First Line	:	10178 SWEETGRASS CIR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-0934
Country	:	US
Telephone Number	:	239-398-4972
Fax Number	:

Provider Business Practice Location Address
First Line	:	10178 SWEETGRASS CIR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-0934
Country	:	US
Telephone Number	:	239-398-4972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	12/31/2025

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