| Doctor Name: | AMY YVONNE POLAND |
| NPI Number: | 1053687608 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCMHC |
| License Number: | 068.0075195 |
| Business Practice Address: | 364 Dorset Street, Suite 204 South Burlington, VT - 05403 |
| Business Phone Number: | 8026589440 |
| Business Fax Number: | 8026589443 |
| Mailing Address: | 364 Dorset Street, Suite 204, SOUTH BURLINGTON |
| State: | VT |
| Postal Code: | 05403 |
| Phone Number: | 8026589440 |
| Fax Number: | 8026589443 |
| NPI Enumeration Date: | 03/28/2012 |
| NPI Last Update Date: | 03/28/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 068.0075195 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |