Provider Demographics
NPI:1124541495
Name:POLOKOFF, JAYNE STEPHANIE (MSW)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:STEPHANIE
Last Name:POLOKOFF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 CRAIGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-4113
Mailing Address - Country:US
Mailing Address - Phone:845-699-4786
Mailing Address - Fax:
Practice Address - Street 1:837 CRAIGVILLE ROAD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918
Practice Address - Country:US
Practice Address - Phone:845-699-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBV34567Medicaid