MEDICARE: MR. JAMES R POLZNER LISW

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	I-0004022	OH
2	1041C0700X	Clinical Social Worker	I-4022	OH

General Provider Information

NPI Number	:	1891018578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES R POLZNER LISW

Provider Business Mailing Address
First Line	:	515 TREBISKY RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2827
Country	:	US
Telephone Number	:	261-210-4702
Fax Number	:	216-486-2006

Provider Business Practice Location Address
First Line	:	515 TREBISKY RD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2827
Country	:	US
Telephone Number	:	261-210-4702
Fax Number	:	216-486-2006

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	11/06/2024

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