Provider Demographics
NPI:1760410872
Name:POLITO, GERARD A I (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:A
Last Name:POLITO
Suffix:I
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GLEN HOLLOW DR.
Mailing Address - Street 2:APT. B7
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742
Mailing Address - Country:US
Mailing Address - Phone:631-447-5389
Mailing Address - Fax:
Practice Address - Street 1:1641 DEER PARK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729
Practice Address - Country:US
Practice Address - Phone:631-447-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028830-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN71921Medicare ID - Type Unspecified