Provider Demographics
NPI:1376706309
Name:POLAK, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:POLAK
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 1:3351 STEUBEN AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2805
Mailing Address - Country:US
Mailing Address - Phone:718-920-6033
Mailing Address - Fax:718-655-8070
Practice Address - Street 1:3351 STEUBEN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2805
Practice Address - Country:US
Practice Address - Phone:718-920-6033
Practice Address - Fax:718-655-8070
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019561103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical