Provider Demographics
NPI:1902123433
Name:POLIDORO-YODICE, GINA (LMHC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:POLIDORO-YODICE
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 1:1155 JOSELSON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2033
Mailing Address - Country:US
Mailing Address - Phone:631-445-9875
Mailing Address - Fax:
Practice Address - Street 1:1155 JOSELSON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2033
Practice Address - Country:US
Practice Address - Phone:631-445-9878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP74642101YM0800X
NY006066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health