Provider Demographics
NPI:1619041100
Name:POLOVINA, SHARON RUTH
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RUTH
Last Name:POLOVINA
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 1:1707 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-464-0232
Mailing Address - Fax:518-464-0202
Practice Address - Street 1:1707 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-464-0232
Practice Address - Fax:518-464-0202
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0617091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000402874001OtherBLUESHIELD
NY7350172OtherEMPIEPPN
NY550 146OtherCDPHP
NY051028000018OtherFIDELIS
NYN36E41OtherEMPIRE BCBS
NY000402874001OtherBLUESHIELD