Provider Demographics
NPI:1609949452
Name:POLLACK, BARBARA (BA, CMT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:POLLACK
Suffix:
Gender:F
Credentials:BA, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N MCDOWELL BLVD APT C-162
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-0397
Mailing Address - Country:US
Mailing Address - Phone:707-778-7185
Mailing Address - Fax:
Practice Address - Street 1:405 E D ST STE 108
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3173
Practice Address - Country:US
Practice Address - Phone:707-778-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACMT171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor