Healthcare Provider Details

I. General information

NPI: 1164761375
Provider Name (Legal Business Name): BEATRICE POLYNICE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 LARK DR, WHITNEY M. YOUNG JR. HEALTH CENTER
ALBANY NY
12207-1300
US

IV. Provider business mailing address

920 LARK DRIVE
ALBANY NY
12207
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-4771
  • Fax: 518-242-4770
Mailing address:
  • Phone: 518-465-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number083036-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: