Individual provider Active NPI

Carol Ann Polevoi, M.A. M.F.T.

  • Marriage & Family Therapist
  • Encino, CA
National Provider Identifier
1154407161
Registry record updated Oct 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
32105 Issued in CA
Practice address
16055 Ventura Blvd Ste 717
Encino, CA 91436-2610
Phone
(818) 889-3905
NPI assigned
Oct 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 32105 CA Primary

Addresses

Primary practice location

16055 Ventura Blvd Ste 717
Encino, CA 91436-2610

Mailing address

4930 Balboa Blvd Unit 260734
Encino, CA 91426-7037
Phone (818) 889-3905

Other practice location 1

5923 Kanan Rd
Agoura Hills, CA 91301-1688
Phone (818) 889-3905

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

LicenseStateTypeSpecialty
32105CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Carol a. Polevoi, LMFT/Wellness Coach, Apc Marriage & Family Therapist Current Accepting new patients

Locations

4930 Balboa Blvd
Unit 260734
Encino, CA 91426

16055 Ventura Blvd
Ste 717
Encino, CA 91436
Phone (818) 215-0367

Organizations & group practices 1

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540166400000",
    "number": "1154407161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 BALBOA BLVD UNIT 260734",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914267037",
            "telephone_number": "818-889-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16055 VENTURA BLVD STE 717",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362610",
            "telephone_number": "818-889-3905"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5923 Kanan Rd",
            "address_purpose": "LOCATION",
            "city": "Agoura Hills",
            "state": "CA",
            "postal_code": "913011688",
            "country_code": "US",
            "telephone_number": "818-889-3905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLEVOI",
        "first_name": "CAROL",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "M.A.  M.F.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-31",
        "last_updated": "2018-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "32105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.