Provider Demographics
NPI:1174189260
Name:POLAKOWSKI, EVAN
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:POLAKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BOURNE ST APT B
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2393
Mailing Address - Country:US
Mailing Address - Phone:978-965-1827
Mailing Address - Fax:
Practice Address - Street 1:29 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1400
Practice Address - Country:US
Practice Address - Phone:508-853-0556
Practice Address - Fax:508-853-1308
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator