Provider Demographics
NPI:1558674366
Name:POLIZZI, DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:POLIZZI
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 1:202 MYERS RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9702
Mailing Address - Country:US
Mailing Address - Phone:317-718-8436
Mailing Address - Fax:317-718-8438
Practice Address - Street 1:202 MYERS RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9702
Practice Address - Country:US
Practice Address - Phone:317-718-8436
Practice Address - Fax:317-718-8438
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000072101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)