Provider Demographics
NPI:1962167023
Name:POLONSKY, KIMBERLY (LSW, CSC, BC-TMH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:POLONSKY
Suffix:
Gender:F
Credentials:LSW, CSC, BC-TMH
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW, CSC, BC-TMH
Mailing Address - Street 1:3782 LOWER LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3333
Mailing Address - Country:US
Mailing Address - Phone:484-942-0055
Mailing Address - Fax:
Practice Address - Street 1:3782 LOWER LEWIS RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3333
Practice Address - Country:US
Practice Address - Phone:484-942-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123177104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty