Provider Demographics
NPI:1457638983
Name:POLLACK, JUDITH S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:S
Last Name:POLLACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 113TH ST
Mailing Address - Street 2:APT. 4G
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6513
Mailing Address - Country:US
Mailing Address - Phone:718-544-5180
Mailing Address - Fax:718-487-3261
Practice Address - Street 1:7636 113TH ST
Practice Address - Street 2:APT. 4G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6513
Practice Address - Country:US
Practice Address - Phone:718-544-5180
Practice Address - Fax:718-487-3261
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY74432491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical