Provider Demographics
NPI:1497022255
Name:POLI, ALYCE WARE (MSED)
Entity Type:Individual
Prefix:
First Name:ALYCE
Middle Name:WARE
Last Name:POLI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BONNIE CT
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2768
Mailing Address - Country:US
Mailing Address - Phone:845-319-3225
Mailing Address - Fax:
Practice Address - Street 1:2 BONNIE COURT
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563
Practice Address - Country:US
Practice Address - Phone:845-319-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY638325103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst