Provider Demographics
NPI:1265647663
Name:POLIVY, ELLEN LURIE (MSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:LURIE
Last Name:POLIVY
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 1:531 MAIN ST
Mailing Address - Street 2:APT 1019
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0105
Mailing Address - Country:US
Mailing Address - Phone:212-362-2076
Mailing Address - Fax:212-750-6243
Practice Address - Street 1:531 MAIN ST
Practice Address - Street 2:APT 1019
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0105
Practice Address - Country:US
Practice Address - Phone:212-362-2076
Practice Address - Fax:212-750-6243
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018251-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7200Medicare ID - Type UnspecifiedEMPIRE BLUE CROSS