MEDICARE: JOAN POELVOORDE 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	PRO19774	NY

General Provider Information

NPI Number	:	1578610762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN POELVOORDE LCSW

Provider Business Mailing Address
First Line	:	PO BOX 265
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-0265
Country	:	US
Telephone Number	:	646-473-0138
Fax Number	:	646-473-0140

Provider Business Practice Location Address
First Line	:	19 W 34TH ST
Second Line	:	PENTHOUSE
City	:	NEW YORK
State	:	NY
Zip	:	10001-3006
Country	:	US
Telephone Number	:	646-473-0138
Fax Number	:	646-473-0138

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	01/25/2026

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Directions to “ JOAN POELVOORDE LCSW” Practice Location

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