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General NPI Number Information
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NPI Number | 1679709307
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Entity Type | Individual
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Provider Name | GISELE POLANCO LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 544 ELMWOOD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02907-1820
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Country | US
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Telephone | 401-781-2727
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Fax | 401-781-2828
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Provider Business Mailing Address
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Address Line | 544 ELMWOOD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02907-1820
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Country | US
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Telephone | 401-781-2727
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Fax | 401-781-2828
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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 | RI
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