Provider Demographics
NPI:1841614211
Name:POLIARD, MIREILLE
Entity Type:Individual
Prefix:
First Name:MIREILLE
Middle Name:
Last Name:POLIARD
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 1:712 E 27TH ST
Mailing Address - Street 2:APT. 5F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2255
Mailing Address - Country:US
Mailing Address - Phone:347-640-9087
Mailing Address - Fax:
Practice Address - Street 1:712 E 27TH ST
Practice Address - Street 2:APT. 5F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2255
Practice Address - Country:US
Practice Address - Phone:347-640-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor