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Individual

MR. ANGEL POLANCO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CASAC

Contact information

Practice address
819C E 161ST ST, BRONX, NY 10459-3951
(718) 503-7763
(718) 503-7751
Mailing address
819C E 161ST ST, BRONX, NY 10459-3951
(718) 503-7763
(718) 503-7751

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11802
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11802
NEW YORK STATE
NY
Enumeration date
01/29/2009
Last updated
01/29/2009
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