Provider Demographics
NPI:1225529159
Name:POLAKOW, JENICA (LCSW)
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:
Last Name:POLAKOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 BLUE MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5457
Mailing Address - Country:US
Mailing Address - Phone:805-380-8331
Mailing Address - Fax:
Practice Address - Street 1:790 E SANTA CLARA ST STE 102
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2967
Practice Address - Country:US
Practice Address - Phone:805-830-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW796231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical