MEDICARE: DR. POLLY ANNA PETERSON PARKER 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	6794	FL
2	1041C0700X	Clinical Social Worker	0904003711	VA
3	1041C0700X	Clinical Social Worker	110132	TX

General Provider Information

NPI Number	:	1346927654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. POLLY ANNA PETERSON PARKER LCSW

Provider Business Mailing Address
First Line	:	3761 FM 697
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-3734
Country	:	US
Telephone Number	:	954-295-4923
Fax Number	:

Provider Business Practice Location Address
First Line	:	3761 FM 697
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-3734
Country	:	US
Telephone Number	:	954-295-4923
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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