MEDICARE: LOVELY POOLE LMSW

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	104100000X	Social Worker	LMSW-14068	AZ

General Provider Information

NPI Number	:	1801217120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOVELY POOLE LMSW

Provider Business Mailing Address
First Line	:	13616 W ALVARADO DR
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85395-2419
Country	:	US
Telephone Number	:	404-396-7142
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 W HAPPY VALLEY RD STE 4
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-3709
Country	:	US
Telephone Number	:	602-699-6045
Fax Number	:

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

Provider Enumeration Date	:	01/05/2014
Last Update Date	:	01/12/2023

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Directions to “ LOVELY POOLE LMSW” Practice Location

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