Provider Demographics
NPI:1598580839
Name:POLANCO GUZMAN, ADRIA (MA)
Entity type:Individual
Prefix:
First Name:ADRIA
Middle Name:
Last Name:POLANCO GUZMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 7295
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784-3562
Mailing Address - Country:US
Mailing Address - Phone:787-204-4251
Mailing Address - Fax:
Practice Address - Street 1:CALLE BALDORIOTY #63 OESTE
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-0000
Practice Address - Country:US
Practice Address - Phone:787-204-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008008103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling