Healthcare Provider Details

I. General information

NPI: 1699128884
Provider Name (Legal Business Name): ARIEL POLSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

8721 E PLACITA PLAYA
TUCSON AZ
85715-5647
US

V. Phone/Fax

Practice location:
  • Phone: 520-633-8074
  • Fax:
Mailing address:
  • Phone: 520-243-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-18297
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: