Provider Demographics
NPI:1376151597
Name:POLANSKI, PAUL AFANASI (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:AFANASI
Last Name:POLANSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 FIECHTNER DR S STE C
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8735
Mailing Address - Country:US
Mailing Address - Phone:701-630-8813
Mailing Address - Fax:
Practice Address - Street 1:3217 FIECHTNER DR S STE C
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8735
Practice Address - Country:US
Practice Address - Phone:701-630-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND53841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical