Diane Kay Polak-Gomez, L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS15918 Issued in CA

Practice address

2275 Parkview LN
Chino Hills, CA 91709-1768

Phone

(909) 706-2740

Fax

(909) 591-8736

NPI assigned

Jan 19, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1851696009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 PARKVIEW LN",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917091768",
            "telephone_number": "909-706-2740",
            "fax_number": "909-591-8736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2275 PARKVIEW LN",
            "city": "CHINO HILLS",
            "state": "CA",
            "postal_code": "917091768",
            "telephone_number": "909-706-2740",
            "fax_number": "909-591-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAK-GOMEZ",
        "first_name": "DIANE",
        "middle_name": "KAY",
        "name_prefix": "Mrs.",
        "credential": "L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-19",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS15918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Chino Hills, CA
• Providers in Chino Hills, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; 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.