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General NPI Number Information
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NPI Number | 1881567337
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Entity Type | Individual
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Provider Name | RYLEE POLVERELLI
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Gender | Female
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 3107 MEETING STREET RD
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-7980
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Country | US
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Telephone | 843-654-7464
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Fax |
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Provider Business Mailing Address
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Address Line | 190 E PINCKNEY ST
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City | SUMMERVILLE
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State | SC
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Zip | 29485-7220
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Country | US
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Telephone |
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-84546
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License Number State | SC
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