Provider Demographics
NPI:1154407161
Name:POLEVOI, CAROL ANN (MA MFT)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:POLEVOI
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 BALBOA BLVD UNIT 260734
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-7037
Mailing Address - Country:US
Mailing Address - Phone:818-889-3905
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 717
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2610
Practice Address - Country:US
Practice Address - Phone:818-889-3905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist