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JACQUALINE POLYDOROS LCPC
NPI 1396349379
Counselor - Mental Health in Hagerstown, MD

Active since November 30, 2020PECOS Enrolled
322 E ANTIETAM ST STE 101, HAGERSTOWN, MD 21740(301) 733-2431 Get Directions Write a Review

NPPES record last updated: December 29, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 29, 2025, Nov 30, 2020 (2 updates tracked since 2020).

About Jacqualine Polydoros Lcpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACQUALINE POLYDOROS LCPC (NPI 1396349379) is an individual mental health provider in Hagerstown, Maryland, licensed in Maryland (LC16950) and active in the NPI registry since November 2020. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1396349379
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameJACQUALINE POLYDOROSCredential: LCPC
Location Address322 E ANTIETAM ST STE 101Hagerstown, MD 21740-5736
Mailing Address20115 Professional Blvd Ste 203Hagerstown, MD 21742-6832 · (866) 287-2036
Phone(301) 733-2431
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateNovember 30, 2020
Last NPPES UpdateDecember 29, 20252 updates tracked since enumeration
NPPES CertifiedDecember 29, 2025
✔ NPI 1396349379 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in MD · LC16950
322 E ANTIETAM ST STE 101, Hagerstown, MD 21740
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqualine Polydoros Lcpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6406334127
PECOS Enrollment IDI20260203001297
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jacqualine Polydoros reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Grow Healthcare Group PA
966 mi
Mental Health
66 W FLAGLER ST STE 900
Miami, FL 33130
  • Reassigned Medicare billing, District of Columbia enrollment
  • 1,424 clinicians in this Medicare group
NPI 1245845932 (786) 244-7711

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 19

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DIAMOND SINES
Social Worker
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (301) 733-2431
KATHLEEN Y. AMANO
Counselor
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (301) 733-2431
THE WESTERN MARYLAND COUNSELING CENTER
Community/Behavioral Health
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (301) 733-2431
BRENNA PAPE
Social Worker
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (301) 733-2431
AMBER CHRISTINE CHROBOT LMSW
Social Worker
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (301) 733-2431
MRS. MICHELLE ANN KISER OWUSU LCSW-C
Social Worker (Clinical)
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (017) 332-4313
NIA IMANI ELMORE
Social Worker
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (301) 733-2431
KRISTINE L HEROLD
Social Worker
322 E ANTIETAM ST STE 101
HAGERSTOWN, MD 21740
Washington County (301) 733-2431

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacqualine Polydoros's NPI number?

The NPI number for Jacqualine Polydoros is 1396349379. It was assigned to this individual provider in the NPPES registry on November 30, 2020.

Where is Jacqualine Polydoros located?

Jacqualine Polydoros practices at 322 E Antietam St Ste 101, Hagerstown, MD 21740. The listed phone number is (301) 733-2431.

What is Jacqualine Polydoros's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Jacqualine Polydoros enrolled in Medicare?

Yes. Jacqualine Polydoros is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jacqualine Polydoros's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacqualine Polydoros reassigns Medicare benefits to Grow Healthcare Group PA (Miami, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacqualine Polydoros's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jacqualine Polydoros was last updated on December 29, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.