Provider Demographics
NPI:1285026542
Name:POLZER-GRIECO, NICOLE ANNE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:POLZER-GRIECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANNE
Other - Last Name:POLZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3022 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-2806
Mailing Address - Country:US
Mailing Address - Phone:610-657-1777
Mailing Address - Fax:
Practice Address - Street 1:3022 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-2806
Practice Address - Country:US
Practice Address - Phone:610-657-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health