Provider Demographics
NPI:1710186333
Name:POLONYI, ATTILA J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ATTILA
Middle Name:J
Last Name:POLONYI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DARTMOUTH STREET
Mailing Address - Street 2:#72
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:917-536-6090
Mailing Address - Fax:718-246-9423
Practice Address - Street 1:4 DARTMOUTH ST APT 72
Practice Address - Street 2:#72
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5111
Practice Address - Country:US
Practice Address - Phone:917-536-6090
Practice Address - Fax:718-246-9423
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0520891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02437176Medicaid
NY98P3341OtherNY PRESBYTERIAN COMMUNITY
NY02437176Medicaid
Q26603Medicare UPIN