Provider Demographics
NPI:1891844205
Name:POLISE, LIVIA (LCSW)
Entity type:Individual
Prefix:
First Name:LIVIA
Middle Name:
Last Name:POLISE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 KINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2106
Mailing Address - Country:US
Mailing Address - Phone:516-728-4969
Mailing Address - Fax:
Practice Address - Street 1:175 NASSAU RD
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-2016
Practice Address - Country:US
Practice Address - Phone:516-623-1644
Practice Address - Fax:516-623-3125
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0458601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical