Provider Demographics
NPI:1780160176
Name:POLANCO, DEANNA NICOLE
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:NICOLE
Last Name:POLANCO
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 1:322 S ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3843
Mailing Address - Country:US
Mailing Address - Phone:516-658-4082
Mailing Address - Fax:
Practice Address - Street 1:322 S ROBERTS ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-3843
Practice Address - Country:US
Practice Address - Phone:516-658-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician