Provider Demographics
NPI:1689077166
Name:POLLACK, BRIAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:POLLACK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SPRINGFIELD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2611
Mailing Address - Country:US
Mailing Address - Phone:973-637-0572
Mailing Address - Fax:908-273-9548
Practice Address - Street 1:450 SPRINGFIELD AVE STE 302
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2611
Practice Address - Country:US
Practice Address - Phone:973-637-0572
Practice Address - Fax:908-273-9548
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056078001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical