Provider Demographics
NPI:1689909624
Name:POLYNSKY, JERRY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:POLYNSKY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:YURI
Other - Middle Name:
Other - Last Name:POLYNSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:303 BEVERLEY RD
Mailing Address - Street 2:APT. 7G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3151
Mailing Address - Country:US
Mailing Address - Phone:718-854-5173
Mailing Address - Fax:
Practice Address - Street 1:2925A KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1805
Practice Address - Country:US
Practice Address - Phone:718-382-0045
Practice Address - Fax:718-859-7157
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0771911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical