Provider Demographics
NPI:1003935149
Name:POLETIKA, NINA MARIE (MFTI)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:MARIE
Last Name:POLETIKA
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1613
Mailing Address - Country:US
Mailing Address - Phone:650-326-1340
Mailing Address - Fax:650-326-1340
Practice Address - Street 1:375 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1613
Practice Address - Country:US
Practice Address - Phone:650-326-6576
Practice Address - Fax:650-326-1340
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51601106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist