Provider Demographics
NPI:1659860609
Name:POLERA, ROSEMARIE (MA, CAS)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:POLERA
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23120
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-0420
Mailing Address - Country:US
Mailing Address - Phone:804-343-6500
Mailing Address - Fax:
Practice Address - Street 1:11600 HOLMAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5661
Practice Address - Country:US
Practice Address - Phone:804-935-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000180103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty