Provider Demographics
NPI:1740407428
Name:CHARETTE, POLLY A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:A
Last Name:CHARETTE
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 1:8825 PERIMETER PARK BLVD STE 601
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1122
Mailing Address - Country:US
Mailing Address - Phone:904-419-7327
Mailing Address - Fax:
Practice Address - Street 1:8825 PERIMETER PARK BLVD STE 601
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1122
Practice Address - Country:US
Practice Address - Phone:904-419-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037201041C0700X
FLSW118641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical