Basic Information
| Provider Information | |||||||||
| NPI: | 1972014058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLSKY | ||||||||
| FirstName: | MARCY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5801 LEMONA AVE | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914113005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187492245 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19720 VENTURA BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913642676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188040322 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2017 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 19086 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.