Provider Demographics
NPI:1730567926
Name:POLENDO, RICARDO (LICSW)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:POLENDO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 LYDIA DR W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1924
Mailing Address - Country:US
Mailing Address - Phone:651-428-0875
Mailing Address - Fax:
Practice Address - Street 1:402 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-4400
Practice Address - Country:US
Practice Address - Phone:651-266-7900
Practice Address - Fax:651-266-7854
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical