MEDICARE: DR. KATIE LYNNE PFEIFFER POLEN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103T00000X	Psychologist	RPS2011007	CA
4	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1184848426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATIE LYNNE PFEIFFER POLEN PSY.D.

Provider Business Mailing Address
First Line	:	683 VALLEY VISTA DR
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1639
Country	:	US
Telephone Number	:	805-795-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	683 VALLEY VISTA DR
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1639
Country	:	US
Telephone Number	:	805-795-3221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	03/03/2024

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