Provider Demographics
NPI:1225355530
Name:POLLICK, MELISSA A (BCABA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:POLLICK
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 NE 2ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4840
Mailing Address - Country:US
Mailing Address - Phone:954-683-9898
Mailing Address - Fax:
Practice Address - Street 1:10112 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2349
Practice Address - Country:US
Practice Address - Phone:305-401-5259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-03-1060103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst