Provider Demographics
NPI:1174114409
Name:POLITE, ROCKY A (LMSW, MED)
Entity type:Individual
Prefix:
First Name:ROCKY
Middle Name:A
Last Name:POLITE
Suffix:
Gender:M
Credentials:LMSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26201 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-6260
Mailing Address - Country:US
Mailing Address - Phone:302-236-0175
Mailing Address - Fax:
Practice Address - Street 1:26201 SCHOOL LN
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-6260
Practice Address - Country:US
Practice Address - Phone:302-236-0175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-0000147104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty