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General NPI Number Information
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NPI Number | 1194555292
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Entity Type | Individual
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Provider Name | MALKA POLONETSKY LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/03/2024
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Last Update Date | 08/03/2024
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Provider Practice Location Address
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Address Line | 3201 ZANDER DR APT 302
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City | KISSIMMEE
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State | FL
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Zip | 34747-1176
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Country | US
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Telephone | 786-223-3178
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Fax |
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Provider Business Mailing Address
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Address Line | 10 TAFT AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5664
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Country | US
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Telephone | 786-223-3178
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH19308
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License Number State | FL
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