Provider Demographics
NPI:1891840005
Name:POLLOCK, ELIZABETH S (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:S
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 STANTON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6806
Mailing Address - Country:US
Mailing Address - Phone:617-734-7869
Mailing Address - Fax:617-734-5278
Practice Address - Street 1:41 STANTON RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-6806
Practice Address - Country:US
Practice Address - Phone:617-277-3970
Practice Address - Fax:617-734-5278
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10097211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO2682OtherBLUE CROSS BLUE SHIELD
P20357Medicare ID - Type Unspecified