Provider Demographics
NPI:1205963717
Name:POLISCHUK, PABLO (PHD)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:POLISCHUK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:POLISCHUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:205 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2255
Mailing Address - Country:US
Mailing Address - Phone:978-468-4151
Mailing Address - Fax:
Practice Address - Street 1:205 WILLOW ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2255
Practice Address - Country:US
Practice Address - Phone:978-468-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2770103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist