Provider Demographics
NPI:1437762184
Name:POLAK, CARMELLA
Entity Type:Individual
Prefix:
First Name:CARMELLA
Middle Name:
Last Name:POLAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMELLA
Other - Middle Name:
Other - Last Name:CUOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 BAKERS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2573
Mailing Address - Country:US
Mailing Address - Phone:091-733-4791
Mailing Address - Fax:
Practice Address - Street 1:5301 BUTLER ST STE 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15201-2658
Practice Address - Country:US
Practice Address - Phone:412-441-9786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health