Healthcare Provider Details

I. General information

NPI: 1568348340
Provider Name (Legal Business Name): MARIANA ESPINOSA POLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

33 W 60TH ST FL 6
NEW YORK NY
10023-7905
US

IV. Provider business mailing address

310 BLEECKER ST # 2
BROOKLYN NY
11237-5205
US

V. Phone/Fax

Practice location:
  • Phone: 954-401-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: