Provider Demographics
NPI:1821087602
Name:POLLOCK, RICHARD EDWARD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EDWARD
Last Name:POLLOCK
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:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281-0104
Mailing Address - Country:US
Mailing Address - Phone:207-583-6766
Mailing Address - Fax:
Practice Address - Street 1:20 PARIS ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5654
Practice Address - Country:US
Practice Address - Phone:207-743-7833
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC17711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM3267Medicare ID - Type Unspecified