Active NPI
Gwynn Johnson Polidoro, LCSW
- Clinical Social Worker
- Radford, VA
National Provider Identifier
1528027075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0904001071
- Practice address
- 200 8TH St
Radford, VA 24141-2426 - Phone
- (540) 731-0838
- Fax
- (540) 731-3375
- NPI assigned
- Mar 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904001071 | VA | Primary |
Addresses
Primary practice location
200 8TH St
Radford, VA 24141-2426
Mailing address
200 8TH St
Radford, VA 24141-2426
Phone (540) 731-0838
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8906203 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904001071 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1528027075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 8TH ST",
"city": "RADFORD",
"state": "VA",
"postal_code": "241412426",
"telephone_number": "540-731-0838",
"fax_number": "540-731-3375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 8TH ST",
"city": "RADFORD",
"state": "VA",
"postal_code": "241412426",
"telephone_number": "540-731-0838",
"fax_number": "540-731-3375"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLIDORO",
"first_name": "GWYNN",
"middle_name": "JOHNSON",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-22",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904001071",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8906203",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Radford, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.