Active NPI
Jaclyn Holly Polsky, PSY.D.
- Clinical Psychologist
- Fort Lauderdale, FL
National Provider Identifier
1043552045
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY8678
- Practice address
- 514 SE 11TH CT
Suite a
Fort Lauderdale, FL 33316-1111 - Phone
- (954) 764-7155
- NPI assigned
- Mar 18, 2013
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY8678 | FL | Primary |
Addresses
Primary practice location
514 SE 11TH CT
Suite a
Fort Lauderdale, FL 33316-1111
Mailing address
13000 NW 5TH St
Plantation, FL 33325-2221
Phone (954) 303-0868
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY8678 | FL | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Paulina Martinez and Associates PA | Past | Accepting new patients | |
| Jessica M Gurvit PSYD PA | Clinical | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Fort Lauderdale, FL
- NPI 1437554094
-
- Clinical Psychologist
- Ft Lauderdale, FL
- NPI 1275921728
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363564800000",
"number": "1043552045",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13000 NW 5TH ST",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333252221",
"telephone_number": "954-303-0868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "514 SE 11TH CT",
"address_2": "SUITE A",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333161111",
"telephone_number": "954-764-7155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLSKY",
"first_name": "JACLYN",
"middle_name": "HOLLY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-18",
"last_updated": "2013-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY8678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.