Provider Demographics
NPI:1851721195
Name:POLANA, BRADY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BRADY
Middle Name:
Last Name:POLANA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WAVERLY HALL CLOSE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2118
Mailing Address - Country:US
Mailing Address - Phone:706-302-3785
Mailing Address - Fax:
Practice Address - Street 1:100 WAVERLY HALL CLOSE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2118
Practice Address - Country:US
Practice Address - Phone:706-302-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006308104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker