Provider Demographics
NPI:1295410090
Name:POLANCO ROSADO, JOSSIEL DAVID (LMSW)
Entity type:Individual
Prefix:
First Name:JOSSIEL
Middle Name:DAVID
Last Name:POLANCO ROSADO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3034 GRAND CONCOURSE APT D5S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1453
Mailing Address - Country:US
Mailing Address - Phone:201-838-3834
Mailing Address - Fax:
Practice Address - Street 1:3704 91ST ST FL 2
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7914
Practice Address - Country:US
Practice Address - Phone:347-730-4249
Practice Address - Fax:347-730-4216
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119061104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker