Provider Demographics
NPI:1053961177
Name:POLEY, KEVIN WAYNE (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WAYNE
Last Name:POLEY
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2930
Mailing Address - Country:US
Mailing Address - Phone:862-801-2332
Mailing Address - Fax:
Practice Address - Street 1:51 SOUTH ST STE 5
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8107
Practice Address - Country:US
Practice Address - Phone:862-801-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00684400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional