Polly A. Charette, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW11864 Issued in FL

Practice address

8825 Perimeter Park Blvd Ste 601
Jacksonville, FL 32216-1122

Phone

(904) 419-7327

NPI assigned

Apr 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1740407428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8825 PERIMETER PARK BLVD STE 601",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161122",
            "telephone_number": "904-419-7327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8825 PERIMETER PARK BLVD STE 601",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161122",
            "telephone_number": "904-419-7327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARETTE",
        "first_name": "POLLY",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003720",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW11864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Renee Chappell, APRN
• Austin J Chaput, D.O.
• Chantel Charais, APRN
• Jay F Charboneau, SW
• Michael Charette
• Kayla Charland, CF SLP
• Charles C Greene MD PHD PA
• Charles C Greene MD PHD PA
• Charles C Greene MD PHD PA
• Charles C Greene, MD, PHD

• Clinical Social Worker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.