Healthcare Provider Details

I. General information

NPI: 1083830525
Provider Name (Legal Business Name): CHRISTINA POLINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA HOWELLS

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

IV. Provider business mailing address

1526 WALDEN AVE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-6700
  • Fax:
Mailing address:
  • Phone: 716-895-6700
  • Fax: 716-332-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082402
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: