Provider Demographics
NPI:1265560270
Name:POLAK, ANNE WHITTIER (LCPC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:WHITTIER
Last Name:POLAK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-4324
Mailing Address - Country:US
Mailing Address - Phone:207-647-5782
Mailing Address - Fax:
Practice Address - Street 1:32 N HIGH ST
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1125
Practice Address - Country:US
Practice Address - Phone:207-647-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional