MEDICARE: MR. KEVIN WAYNE POLEY MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00684400	NJ

General Provider Information

NPI Number	:	1053961177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN WAYNE POLEY MS, LPC

Provider Business Mailing Address
First Line	:	16 LAWRENCE AVE
Second Line	:
City	:	STANHOPE
State	:	NJ
Zip	:	07874-2930
Country	:	US
Telephone Number	:	862-801-2332
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 SOUTH ST STE 5
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-8107
Country	:	US
Telephone Number	:	862-801-2332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2019
Last Update Date	:	09/19/2019

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