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NPI Code Detail

MEDICARE: MR. TREY J POLESKY LCSW

MEDICARE: MR. TREY J POLESKY 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
1104100000XSocial Worker150012634IL
21041C0700XClinical Social Worker11031SC
31041C0700XClinical Social Worker149015330IL
41041C0700XClinical Social Worker66343CA

General Provider Information

NPI Number : 1992010193
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TREY J POLESKY LCSW
Provider Business Mailing Address
First Line : 2910 HARRIS ST
Second Line :
City : EUREKA
State : CA
Zip : 95503-4811
Country : US
Telephone Number : 707-840-5511
Fax Number : 877-761-3132
Provider Business Practice Location Address
First Line : 2910 HARRIS ST
Second Line :
City : EUREKA
State : CA
Zip : 95503-4811
Country : US
Telephone Number : 707-840-5511
Fax Number : 877-761-3132
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2010
Last Update Date : 09/17/2018

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Directions to “ MR. TREY J POLESKY LCSW” Practice Location

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