Provider Demographics
NPI:1144307513
Name:POLSKY, SUSAN ALISE
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ALISE
Last Name:POLSKY
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 1:10708 NW 12TH MNR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6995
Mailing Address - Country:US
Mailing Address - Phone:954-473-2748
Mailing Address - Fax:954-473-2748
Practice Address - Street 1:10708 NW 12TH MNR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6995
Practice Address - Country:US
Practice Address - Phone:954-473-2748
Practice Address - Fax:954-473-2748
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services