Individual
RITA IRENE POLIVICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., LCSW,
Contact information
Practice address
3010 E STATE BLVD, FORT WAYNE, IN 46805-4700
(260) 471-2300
Mailing address
P.O. BOX 9532, FORT WAYNE, IN 46899-9532
(260) 437-1248
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
34003316A
IN
101YM0800X
Mental Health Counselor
MH4219
FL
Other
Enumeration date
06/26/2009
Last updated
06/26/2009
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