| Doctor Name: | CONNIE G POLOVINA |
| NPI Number: | 1003146739 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW- C |
| License Number: | 16064 |
| Business Practice Address: | 540 Riverside Dr Salisbury, MD - 218015352 |
| Business Phone Number: | 4105483333 |
| Business Fax Number: | 4105483341 |
| Mailing Address: | 2702 Cinder Lane, QUANTICO |
| State: | MD |
| Postal Code: | 218562502 |
| Phone Number: | 4108732960 |
| Fax Number: | 4108732590 |
| NPI Enumeration Date: | 12/31/2009 |
| NPI Last Update Date: | 09/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 16064 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |