Provider Demographics
NPI:1326074956
Name:POLANSKY, DONALD B (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:B
Last Name:POLANSKY
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PLAZA MIDDLESEX
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-347-9911
Mailing Address - Fax:860-347-8120
Practice Address - Street 1:300 PLAZA MIDDLESEX
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-347-9911
Practice Address - Fax:860-347-8120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000812104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
158001OtherMHN
989960OtherUBH
1048463OtherCIGNA
P1001751OtherOXFORD
CT140000812CT04OtherBCBS
CT4223081OtherAETNA
108472OtherVALUE OPTIONS