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General NPI Number Information
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NPI Number | 1659925642
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Entity Type | Individual
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Provider Name | MARSHA MARIANA POLANCO
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Gender | Female
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Dates
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Enumeration Date | 07/28/2019
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Last Update Date | 07/28/2019
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Provider Practice Location Address
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Address Line | 1214 POST RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-6008
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Country | US
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Telephone | 203-516-7080
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Fax |
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Provider Business Mailing Address
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Address Line | 193 FRENCHTOWN RD
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1906
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Country | US
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Telephone | 203-516-7080
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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