Provider Demographics
NPI:1407091945
Name:POLONI, HARVEY JAMES (MED , LPC)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:JAMES
Last Name:POLONI
Suffix:
Gender:M
Credentials:MED , LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 W ONYX AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2118
Mailing Address - Country:US
Mailing Address - Phone:602-710-0747
Mailing Address - Fax:
Practice Address - Street 1:5613 W ONYX AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2118
Practice Address - Country:US
Practice Address - Phone:602-710-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11725101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)