Provider Demographics
NPI:1689047060
Name:POLIDORO, LUCILLE (TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:
Last Name:POLIDORO
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-3306
Mailing Address - Country:US
Mailing Address - Phone:347-432-1545
Mailing Address - Fax:
Practice Address - Street 1:15 HARVARD DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-3306
Practice Address - Country:US
Practice Address - Phone:347-432-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
NY590249051252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency