Provider Demographics
NPI:1174840797
Name:POLIN, STEPHEN (MFT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:POLIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1635
Mailing Address - Country:US
Mailing Address - Phone:510-654-5109
Mailing Address - Fax:510-654-5109
Practice Address - Street 1:5845 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1635
Practice Address - Country:US
Practice Address - Phone:510-654-5109
Practice Address - Fax:510-654-5109
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMY 7861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-3122738OtherIRS-EIN