Provider Demographics
NPI:1932204021
Name:POLEN-BONITZ, CHRISTIE ANNE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:ANNE
Last Name:POLEN-BONITZ
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 CLIPPER PARK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1405
Mailing Address - Country:US
Mailing Address - Phone:410-889-8970
Mailing Address - Fax:410-889-8971
Practice Address - Street 1:2002 CLIPPER PARK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1405
Practice Address - Country:US
Practice Address - Phone:410-889-8970
Practice Address - Fax:410-889-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD47491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQQ889Medicare ID - Type Unspecified