Provider Demographics
NPI:1184879298
Name:POLANSKY, SUSAN MARY
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARY
Last Name:POLANSKY
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 1:23 RAILROAD AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1858
Mailing Address - Country:US
Mailing Address - Phone:781-883-3076
Mailing Address - Fax:
Practice Address - Street 1:3 MELODY LN
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-1267
Practice Address - Country:US
Practice Address - Phone:781-334-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional