MEDICARE: MR. MATTHEW NEIL POLSKY M.A.

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	106H00000X	Marriage & Family Therapist	MFC 32753	CA

General Provider Information

NPI Number	:	1851514590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW NEIL POLSKY M.A.

Provider Business Mailing Address
First Line	:	4517 ATOLL AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-3304
Country	:	US
Telephone Number	:	818-648-1881
Fax Number	:	818-784-5188

Provider Business Practice Location Address
First Line	:	14724 VENTURA BLVD STE 1100
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3511
Country	:	US
Telephone Number	:	818-648-1881
Fax Number	:	818-784-5188

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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