Alexa Mary Polverino, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

019528 Issued in NY

Practice address

800 Poly PL
Psychology Department, 16TH Floor (116B)
Brooklyn, NY 11209-7104

Phone

(718) 836-6600

NPI assigned

Mar 15, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331769600000",
    "number": "1043585672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9921 4TH AVE",
            "address_2": "UNIT 4A",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112098351",
            "telephone_number": "917-613-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 POLY PL",
            "address_2": "PSYCHOLOGY DEPARTMENT, 16TH FLOOR (116B)",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112097104",
            "telephone_number": "718-836-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLVERINO",
        "first_name": "ALEXA",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-15",
        "last_updated": "2012-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "019528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tatyana N. Polovenko-Kallman, M.D.
• Leslie Eileen Polseno, LCSW
• Refael Yehudah Polter
• Gulnaz Polubarova, MS
• Jahnavi Polumahanti
• Anna Polyak, PHARM.D.
• Daniel Polyak, LP
• Georgiy Polyak, PHARM.D
• Iryna Polyak, MD
• Margarita Polyak

• Psychologist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.