Provider Demographics
NPI:1225815202
Name:POLANCO, YERELIN ANAIRI
Entity Type:Individual
Prefix:
First Name:YERELIN
Middle Name:ANAIRI
Last Name:POLANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 RIVER RD STE 14
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10926-3040
Mailing Address - Country:US
Mailing Address - Phone:845-863-5208
Mailing Address - Fax:
Practice Address - Street 1:118 RIVER RD STE 14
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:NY
Practice Address - Zip Code:10926-3040
Practice Address - Country:US
Practice Address - Phone:845-863-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRBT-23-289669106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician