Active NPI
Gina O'Leary Kirkland Polesetsky, AMFT
- Marriage & Family Therapist
- Culver City, CA
National Provider Identifier
1023698347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 12425
- Practice address
- 9696 Culver Blvd Ste 303
Culver City, CA 90232-2759 - Phone
- (323) 362-6468
- NPI assigned
- Apr 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 12425 | CA | Primary |
Addresses
Primary practice location
9696 Culver Blvd Ste 303
Culver City, CA 90232-2759
Mailing address
9696 Culver Blvd Ste 303
Culver City, CA 90232-2759
Phone (323) 362-6468
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 8, 2024 through Jan 8, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12425 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674777600000",
"number": "1023698347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9696 CULVER BLVD STE 303",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902322759",
"telephone_number": "323-362-6468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9696 CULVER BLVD STE 303",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902322759",
"telephone_number": "323-362-6468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLESETSKY",
"first_name": "GINA",
"middle_name": "O'LEARY KIRKLAND",
"credential": "AMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-11",
"last_updated": "2023-01-27",
"certification_date": "2023-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "12425",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.