MEDICARE: GLADIS DEL CARMEN POLANCO

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1285328336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADIS DEL CARMEN POLANCO

Provider Business Mailing Address
First Line	:	2488 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5203
Country	:	US
Telephone Number	:	940-300-8257
Fax Number	:

Provider Business Practice Location Address
First Line	:	2488 GRAND CONCOURSE RM 2000
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5207
Country	:	US
Telephone Number	:	940-300-8257
Fax Number	:

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

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “ GLADIS DEL CARMEN POLANCO ” Practice Location

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