Provider Demographics
NPI:1629116421
Name:POLLAK, ANDREA LYNN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:POLLAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ELM STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2010
Mailing Address - Country:US
Mailing Address - Phone:203-605-6343
Mailing Address - Fax:860-891-8518
Practice Address - Street 1:15 ELM STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2010
Practice Address - Country:US
Practice Address - Phone:203-605-6343
Practice Address - Fax:860-891-8518
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000611103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist