Provider Demographics
NPI:1699076588
Name:POLCINO, RUTH FRANK (LCSW)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:FRANK
Last Name:POLCINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N CENTRAL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1286
Mailing Address - Country:US
Mailing Address - Phone:323-834-9370
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1286
Practice Address - Country:US
Practice Address - Phone:323-834-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA806881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical