Healthcare Provider Details

I. General information

NPI: 1013971480
Provider Name (Legal Business Name): PATRICIA A POLINSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 POCONO BLVD.
MT. POCONO PA
18344
US

IV. Provider business mailing address

663 POCONO BLVD.
MT. POCONO PA
18344
US

V. Phone/Fax

Practice location:
  • Phone: 570-839-3097
  • Fax: 570-839-8798
Mailing address:
  • Phone: 570-839-3097
  • Fax: 570-839-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW012491
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: