Provider Demographics
NPI:1063986420
Name:POLANCO, KIARA A (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:A
Last Name:POLANCO
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3336
Mailing Address - Country:US
Mailing Address - Phone:201-654-1170
Mailing Address - Fax:
Practice Address - Street 1:80 BROADWAY STE 2D
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2164
Practice Address - Country:US
Practice Address - Phone:332-877-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009099101YM0800X
NJ37PC00989500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional