Provider Demographics
NPI:1770095978
Name:POLANCO, ALEXMI (LMHC)
Entity type:Individual
Prefix:
First Name:ALEXMI
Middle Name:
Last Name:POLANCO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 BROADWAY STE 630
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1611
Mailing Address - Country:US
Mailing Address - Phone:646-470-0639
Mailing Address - Fax:516-490-7472
Practice Address - Street 1:5030 BROADWAY STE 630
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1611
Practice Address - Country:US
Practice Address - Phone:646-470-0639
Practice Address - Fax:516-490-7472
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-27
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health