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Lisa Patrice Polak-Dean

Social Worker

Behavioral Health & Social Service Providers

263 Knickerbocker Rd, Englewood, NJ 07631-1527

PECOS Enrollment

This provider is enrolled in PECOS as LISA POLAK-DEAN.

Based on the most recent information from CMS, provider Lisa Patrice Polak-Dean is legally eligible to order and refer claims for DME services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1265195275
Provider Type
Individual
Full Name
Polak-Dean, Lisa Patrice
Title
Ms.
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
10/17/2021
Last Updated
10/17/2021

Contact Information

Practice Location

263 Knickerbocker Rd, Englewood, NJ 07631-1527

(347) 543-3182

Unlisted Fax

Mailing Location

263 Knickerbocker Rd, Englewood, NJ 07631-1527

(347) 543-3182

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 44SC06017300 New Jersey

Lisa Patrice Polak-Dean

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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