Provider Demographics
NPI:1508199696
Name:POLLOCK, VICKI EILEEN (VICKI POLLOCK, PHD)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:EILEEN
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:VICKI POLLOCK, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17031 BOLLINGER DR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3224
Mailing Address - Country:US
Mailing Address - Phone:310-383-2019
Mailing Address - Fax:310-459-0917
Practice Address - Street 1:17031 BOLLINGER DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3224
Practice Address - Country:US
Practice Address - Phone:310-383-2019
Practice Address - Fax:310-459-0917
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9889103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist