Kimberly Michelle Poli, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

093769-01 Issued in NY

Practice address

620 Madison St
Syracuse, NY 13210-2338

Phone

(315) 426-7769

NPI assigned

Sep 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• 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": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1972224004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4136 TOMMYS TRL",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130903737",
            "telephone_number": "315-491-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 MADISON ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102338",
            "telephone_number": "315-426-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLI",
        "first_name": "KIMBERLY",
        "middle_name": "MICHELLE",
        "name_prefix": "Miss",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "093769-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shramika Pokharel, PA-C
• Carol S Polacek, PHD, FNP, NPP
• Daniel J Polacek, MD
• Robert S Polachek, MD
• Hanish Polavarapu, MD
• Alex Polito
• Deborah L Pollack, PH.D.
• Pollard Consulting Services, PC
• Shirley J. Pollastro
• Mia Nicholle Pollino, PA-C

• Clinical Social Worker in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.