Provider Demographics
NPI:1679599427
Name:HALL, CONSTANCE POLUSZEJKO (LCSW)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:POLUSZEJKO
Last Name:HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 WORTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3536
Mailing Address - Country:US
Mailing Address - Phone:412-466-6179
Mailing Address - Fax:
Practice Address - Street 1:712 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2940
Practice Address - Country:US
Practice Address - Phone:412-731-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0145841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA082011KL6Medicare ID - Type UnspecifiedMEDICARE
PAIP147540Medicare UPIN