Provider Demographics
NPI:1487924957
Name:POLKA, COURTNEY LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN
Last Name:POLKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:SAHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3140 SHERIDAN DR SUITE 209
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-8708
Mailing Address - Country:US
Mailing Address - Phone:716-545-4324
Mailing Address - Fax:716-759-7396
Practice Address - Street 1:3140 SHERIDAN DR SUITE 209
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1422
Practice Address - Country:US
Practice Address - Phone:716-545-4324
Practice Address - Fax:716-759-7396
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0883031041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical