Provider Demographics
NPI:1376289686
Name:POKORAK, LINDSAY
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:POKORAK
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 1:646 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-7151
Mailing Address - Country:US
Mailing Address - Phone:607-242-7420
Mailing Address - Fax:
Practice Address - Street 1:646 MAPLE ST APT 1
Practice Address - Street 2:
Practice Address - City:WATERBURY CENTER
Practice Address - State:VT
Practice Address - Zip Code:05677-7151
Practice Address - Country:US
Practice Address - Phone:607-242-7420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8043311103TS0200X
NY1140417103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool