Provider Demographics
NPI:1801201074
Name:POOLE, JAMES (MA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:POOLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 HUMBOLDT ST
Mailing Address - Street 2:APT 4R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1323
Mailing Address - Country:US
Mailing Address - Phone:607-329-5098
Mailing Address - Fax:
Practice Address - Street 1:278 HUMBOLDT ST
Practice Address - Street 2:APT 4R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:607-329-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent