Provider Demographics
NPI:1225869795
Name:POLANSKY, TYLER ALEXA (MA, LAC, NCC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ALEXA
Last Name:POLANSKY
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 YORK RD
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1045
Mailing Address - Country:US
Mailing Address - Phone:973-295-2755
Mailing Address - Fax:
Practice Address - Street 1:87 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1128
Practice Address - Country:US
Practice Address - Phone:908-751-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00804200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health