Provider Demographics
NPI:1063992899
Name:POLITE, EVELINE LOPES
Entity type:Individual
Prefix:
First Name:EVELINE
Middle Name:LOPES
Last Name:POLITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON ST STE 21
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3964
Mailing Address - Country:US
Mailing Address - Phone:508-821-7071
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON ST STE 21
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3964
Practice Address - Country:US
Practice Address - Phone:508-821-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1078351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical