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General NPI Number Information
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NPI Number | 1164888202
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Entity Type | Individual
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Provider Name | CAROLINE POLSKY
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Gender | Female
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 24 CHANNING ST
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City | NEW LONDON
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State | CT
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Zip | 06320-5735
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Country | US
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Telephone | 203-303-7387
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Fax |
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Provider Business Mailing Address
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Address Line | 189 STORRS RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1683
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Country | US
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Telephone | 860-456-1311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 705497
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7366
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402303
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License Number State | NY
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