Individual
MR. RICHARD KEITH POLACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LBA, BCBA
Contact information
Practice address
30 CUMBERLAND ST., WOONSOCKET, RI 02895
(401) 413-0160
Mailing address
30 CUMBERLAND ST, WOONSOCKET, RI 02895-3341
(401) 413-0160
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
LBA00034
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-12-11616
BEHAVIOR ANALYST CERTIFICATION BOARD
RI
01
—
LBA00034
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DEPARTMENT OF HEALTH
RI
Enumeration date
07/28/2017
Last updated
07/21/2022
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