Healthcare Provider Details

I. General information

NPI: 1205804200
Provider Name (Legal Business Name): POLLY LYBROOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CONGRESSIONAL BLVD STE 115
CARMEL IN
46032-5644
US

IV. Provider business mailing address

109 W 27TH ST
NEW YORK NY
10001-0265
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax: 888-815-3583
Mailing address:
  • Phone: 833-351-8255
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01038468A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: