Provider Demographics
NPI:1942961792
Name:POLANSKY, SHOSHANA SHOSHANA
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:SHOSHANA
Last Name:POLANSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6965 EL CAMINO REAL STE 105-471
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4100
Mailing Address - Country:US
Mailing Address - Phone:858-863-7270
Mailing Address - Fax:
Practice Address - Street 1:6965 EL CAMINO REAL STE 105-471
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4100
Practice Address - Country:US
Practice Address - Phone:858-863-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist