Polo Jean-Louis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LC13459 Issued in ME

Practice address

612 Gray Rd
Gorham, ME 04038-5808

Phone

(207) 200-7050

Fax

(207) 893-1865

NPI assigned

Aug 5, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Poloberg Jean-Louis Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337644800000",
    "number": "1649436908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 GRAY RD",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "040385808",
            "telephone_number": "207-200-7050",
            "fax_number": "207-893-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 GRAY RD",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "040385808",
            "telephone_number": "207-200-7050",
            "fax_number": "207-893-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEAN-LOUIS",
        "first_name": "POLO",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-05",
        "last_updated": "2012-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "LC13459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "POLOBERG",
            "last_name": "JEAN-LOUIS",
            "prefix": "MR.",
            "credential": "LCSW",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Clinical Social Worker in Gorham, ME
• Providers in Gorham, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.