Provider Demographics
NPI:1033227822
Name:POLLACK, JONATHAN P (LCSW, MPA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:P
Last Name:POLLACK
Suffix:
Gender:M
Credentials:LCSW, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CAPITOL PL
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9658
Mailing Address - Country:US
Mailing Address - Phone:518-626-5161
Mailing Address - Fax:518-462-3099
Practice Address - Street 1:170 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2321
Practice Address - Country:US
Practice Address - Phone:518-626-5161
Practice Address - Fax:518-462-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045638-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical