Provider Demographics
NPI:1821197369
Name:POLLACK, DENISE KYLE (MED)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:KYLE
Last Name:POLLACK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 TIFFANY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3041
Mailing Address - Country:US
Mailing Address - Phone:610-392-3862
Mailing Address - Fax:610-559-8274
Practice Address - Street 1:3780 TIFFANY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-3041
Practice Address - Country:US
Practice Address - Phone:610-392-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional