Provider Demographics
NPI:1356824833
Name:POLSTER, JUSTINE MARGARET
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:MARGARET
Last Name:POLSTER
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 1:235 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2205
Mailing Address - Country:US
Mailing Address - Phone:610-329-8274
Mailing Address - Fax:
Practice Address - Street 1:235 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2205
Practice Address - Country:US
Practice Address - Phone:610-329-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134483104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker