Provider Demographics
NPI:1649786989
Name:POLETO, DAVID JAMES JR (BS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:POLETO
Suffix:JR
Gender:M
Credentials:BS
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Other - Credentials:
Mailing Address - Street 1:350 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1834
Mailing Address - Country:US
Mailing Address - Phone:504-952-8405
Mailing Address - Fax:
Practice Address - Street 1:4201 N INTERSTATE 10 SERVICE RD W
Practice Address - Street 2:
Practice Address - City:METARIE
Practice Address - State:LA
Practice Address - Zip Code:70006-1834
Practice Address - Country:US
Practice Address - Phone:225-960-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician