Provider Demographics
NPI:1235186479
Name:POLLOCK, JEAN (MHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6589
Mailing Address - Country:US
Mailing Address - Phone:802-257-1047
Mailing Address - Fax:802-348-7277
Practice Address - Street 1:229 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6589
Practice Address - Country:US
Practice Address - Phone:802-257-1047
Practice Address - Fax:802-348-7277
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011069Medicaid
VTCQAH: 11325993OtherUNIVERSAL CREDENTIALING
VTBCBSVT: 6191OtherPROVIDER #
VTMAGELLAN: 50794000OtherPROVIDER #