Provider Demographics
NPI:1861133993
Name:POOLE, NAOMI (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:MSW, LGSW
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 17370
Mailing Address - Street 2:LOT 4641
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2238
Mailing Address - Country:US
Mailing Address - Phone:919-536-9151
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 17370
Practice Address - Street 2:LOT 4641
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2238
Practice Address - Country:US
Practice Address - Phone:919-536-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30007104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker