Provider Demographics
NPI:1023739380
Name:POLISE, GALEN (MS, LMHC)
Entity type:Individual
Prefix:
First Name:GALEN
Middle Name:
Last Name:POLISE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BEDFORD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4550
Mailing Address - Country:US
Mailing Address - Phone:855-857-6050
Mailing Address - Fax:
Practice Address - Street 1:57 BEDFORD ST STE 105
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4550
Practice Address - Country:US
Practice Address - Phone:855-857-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health