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NPI Code Detail

MEDICARE: POLA BEAGLE LCSW-R

MEDICARE: POLA BEAGLE LCSW-R
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
1104100000XSocial Worker074530NY

General Provider Information

NPI Number : 1841471869
Entity Type Code : Individual
Provider Name (Legal Business Name) : POLA BEAGLE LCSW-R
Provider Business Mailing Address
First Line : PO BOX 725
Second Line :
City : COOPERSTOWN
State : NY
Zip : 13326-0725
Country : US
Telephone Number : 607-674-8416
Fax Number :
Provider Business Practice Location Address
First Line : 15 SCHOOL ST
Second Line :
City : SHERBURNE
State : NY
Zip : 13460-9505
Country : US
Telephone Number : 607-674-8416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2007
Last Update Date : 11/19/2007

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Directions to “ POLA BEAGLE LCSW-R” Practice Location

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