Provider Demographics
NPI:1639589393
Name:MCCALL, POLLY (MA, LCSW)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 79TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6470
Mailing Address - Country:US
Mailing Address - Phone:212-721-4953
Mailing Address - Fax:212-932-2362
Practice Address - Street 1:124 W 79TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6470
Practice Address - Country:US
Practice Address - Phone:212-721-4953
Practice Address - Fax:212-932-2362
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO34945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist