Provider Demographics
NPI:1477960805
Name:POLIAKOFF, CYRUS (LCSW)
Entity Type:Individual
Prefix:
First Name:CYRUS
Middle Name:
Last Name:POLIAKOFF
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 1:257 POWERS ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5035
Mailing Address - Country:US
Mailing Address - Phone:650-815-9334
Mailing Address - Fax:
Practice Address - Street 1:276 5TH AVENUE
Practice Address - Street 2:STE 507, OFFICE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:917-342-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087936-11041C0700X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst