Provider Demographics
NPI:1679383418
Name:POLICH, SERENA LYNN (MSW)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:LYNN
Last Name:POLICH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 GILMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3654
Mailing Address - Country:US
Mailing Address - Phone:406-498-9410
Mailing Address - Fax:
Practice Address - Street 1:200 POLK ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-9611
Practice Address - Country:US
Practice Address - Phone:406-563-7059
Practice Address - Fax:406-563-7895
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT49929104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker