Provider Demographics
NPI:1285014373
Name:POLZONETTI, CHIARA MARIA (LMFT #126322)
Entity Type:Individual
Prefix:
First Name:CHIARA MARIA
Middle Name:
Last Name:POLZONETTI
Suffix:
Gender:F
Credentials:LMFT #126322
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CYS - 405 W. 5TH ST.,
Mailing Address - Street 2:SUITE 590
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2677 N MAIN ST STE 130
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6665
Practice Address - Country:US
Practice Address - Phone:714-274-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126322101YM0800X, 106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty