Basic Information
| Provider Information | |||||||||
| NPI: | 1962931493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLINSKI | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3350 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142141316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168193420 | ||||||||
| FaxNumber: | 7168193430 | ||||||||
| Practice Location | |||||||||
| Address1: | 3350 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142141316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168193420 | ||||||||
| FaxNumber: | 7168193430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 090937 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.