Provider Demographics
NPI:1356452528
Name:POLIZOTI, LEO F (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:F
Last Name:POLIZOTI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2143
Mailing Address - Country:US
Mailing Address - Phone:508-798-2399
Mailing Address - Fax:508-798-2399
Practice Address - Street 1:338 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2143
Practice Address - Country:US
Practice Address - Phone:508-798-2399
Practice Address - Fax:508-798-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2155103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0506141Medicaid
MAW02303Medicare ID - Type UnspecifiedMEDICARE