Provider Demographics
NPI:1003908989
Name:POLING, JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:POLING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOUNT SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3527
Mailing Address - Country:US
Mailing Address - Phone:203-272-9183
Mailing Address - Fax:203-937-3478
Practice Address - Street 1:WEST HAVEN VA - BLDG. 36
Practice Address - Street 2:950 CAMPBELL AVE.
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-937-4830
Practice Address - Fax:203-937-3478
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical