Polidoro, Gwynn Johnson

Polidoro, Gwynn Johnson is an individual health care provider with primary practice located at 200 8Th St , Radford VA 24141-2426. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Polidoro, Gwynn Johnson can be contacted via phone (540) 731-0838.

Contact Information

Primary practice address
200 8Th St Radford VA 24141-2426
Phone: (540) 731-0838
Fax: (540) 731-3375
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 0904001071 Virginia

Profile Details

NPI number 1528027075
LBN Legal business name Polidoro, Gwynn Johnson
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 22nd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528027075 NPPES
Virginia MEDICAID 8906203

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