Provider Demographics
NPI:1154957561
Name:MASSARA-POLYACHENKO, STEPHANIE L I (MHC-P)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:L I
Last Name:MASSARA-POLYACHENKO
Suffix:
Gender:F
Credentials:MHC-P
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:L I
Other - Last Name:MASSARA-POLYACHENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:463 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1811
Mailing Address - Country:US
Mailing Address - Phone:716-893-0062
Mailing Address - Fax:
Practice Address - Street 1:463 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1811
Practice Address - Country:US
Practice Address - Phone:716-893-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health