Provider Demographics
NPI:1134568843
Name:POLIZZI, LYNN ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:ANN
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 BUCKHEAD TER
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1344
Mailing Address - Country:US
Mailing Address - Phone:516-319-1202
Mailing Address - Fax:
Practice Address - Street 1:9017 FOREST HILL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3051
Practice Address - Country:US
Practice Address - Phone:516-319-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0815701041C0700X
VA09040143271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300085751Medicare UPIN