Provider Demographics
NPI:1619185212
Name:POLITE, MOIRA LYNELL (LCSW-QS, LMSW)
Entity type:Individual
Prefix:MS
First Name:MOIRA
Middle Name:LYNELL
Last Name:POLITE
Suffix:
Gender:F
Credentials:LCSW-QS, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33779-0065
Mailing Address - Country:US
Mailing Address - Phone:727-506-7847
Mailing Address - Fax:
Practice Address - Street 1:11556 110TH TER
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33778-3716
Practice Address - Country:US
Practice Address - Phone:646-436-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082593104100000X
FLSW106621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker