Provider Demographics
NPI:1033180435
Name:POLEFRONE, JOANNA M (PHD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:POLEFRONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 WILLIAM FLYNN HWY
Mailing Address - Street 2:SUITE 124F
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-2243
Mailing Address - Country:US
Mailing Address - Phone:412-492-8585
Mailing Address - Fax:412-492-7882
Practice Address - Street 1:4655 WILLIAM FLYNN HWY
Practice Address - Street 2:SUITE 124F
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2243
Practice Address - Country:US
Practice Address - Phone:412-492-8585
Practice Address - Fax:412-492-7882
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008374L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100894282Medicaid
PAS30265Medicare UPIN
PA100894282Medicaid