Provider Demographics
NPI:1891025573
Name:MARTHA POLLOCK LCSW
Entity Type:Organization
Organization Name:MARTHA POLLOCK LCSW
Other - Org Name:AFFILIATED COUNSELORS & THERAPIST
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:650-348-5765
Mailing Address - Street 1:1425 BROADWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3435
Mailing Address - Country:US
Mailing Address - Phone:650-348-5765
Mailing Address - Fax:
Practice Address - Street 1:1425 BROADWAY STE 14
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3435
Practice Address - Country:US
Practice Address - Phone:650-348-5765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17078251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health