Provider Demographics
NPI:1073394243
Name:PODER MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:PODER MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXMI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:646-470-0639
Mailing Address - Street 1:5030 BROADWAY STE 630
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1611
Mailing Address - Country:US
Mailing Address - Phone:646-470-0639
Mailing Address - Fax:
Practice Address - Street 1:5030 BROADWAY STE 630
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1611
Practice Address - Country:US
Practice Address - Phone:646-470-0639
Practice Address - Fax:516-490-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)