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General NPI Number Information
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NPI Number | 1598984833
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Entity Type | Individual
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Provider Name | CATHY POLONCHAK LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 129 E. GERMAN ST.
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-1784
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Country | US
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Telephone | 304-876-3022
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1784
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City | SHEPHERDSTOWN
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State | WV
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Zip | 25443-1784
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Country | US
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Telephone | 304-876-3022
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Fax | 304-876-1421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10681
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | DP00940860
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License Number State | WV
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