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General NPI Number Information
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NPI Number | 1699719435
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Entity Type | Individual
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Provider Name | HEATHER MARIE POLOCHICK MSW
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Gender | Female
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 1011 VETERANS MEMORIAL PKWY
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City | EAST PROVIDENCE
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State | RI
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Zip | 02915-5061
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Country | US
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Telephone | 401-432-1000
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Fax | 401-432-1500
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Provider Business Mailing Address
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Address Line | 1011 VETERANS MEMORIAL PKWY
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City | EAST PROVIDENCE
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State | RI
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Zip | 02915-5061
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Country | US
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Telephone | 401-432-1284
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Fax | 401-432-1509
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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 | ISW01617
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License Number State | RI
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