MEDICARE: AMY POLSINELLI

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	SW15479	FL
2	104100000X	Social Worker	073334	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740505510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY POLSINELLI

Provider Business Mailing Address
First Line	:	3434 HANCOCK BRIDGE PKWY STE 205
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-7005
Country	:	US
Telephone Number	:	818-844-1675
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 HANCOCK BRIDGE PKWY STE 205
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-7005
Country	:	US
Telephone Number	:	818-844-1675
Fax Number	:

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

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	06/07/2024

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