Provider Demographics
NPI:1558418335
Name:HEWSON, POLLY STEVENSON (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:STEVENSON
Last Name:HEWSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 CRESTSTONE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1501
Mailing Address - Country:US
Mailing Address - Phone:858-829-4660
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DRIVE
Practice Address - Street 2:SUITE #B-208
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:858-829-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 103TC1900X, 103TP2701X
CAMFC #41211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist