Provider Demographics
NPI:1811099690
Name:POLSKY, MARILYN F (LCSW MSW)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:F
Last Name:POLSKY
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4436 S SEMINOLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:847-884-0599
Mailing Address - Fax:847-559-2313
Practice Address - Street 1:1325 WILEY RD SUITE 165
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173
Practice Address - Country:US
Practice Address - Phone:847-884-0599
Practice Address - Fax:847-559-1776
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL929430Medicare ID - Type Unspecified