Provider Demographics
NPI:1922157551
Name:MARIANI, POLINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:POLINA
Middle Name:
Last Name:MARIANI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 3RD AVE RM 205
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3679
Mailing Address - Country:US
Mailing Address - Phone:347-357-3160
Mailing Address - Fax:
Practice Address - Street 1:1651 3RD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3679
Practice Address - Country:US
Practice Address - Phone:917-621-6096
Practice Address - Fax:212-222-7200
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065290-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker