Provider Demographics
NPI:1902815236
Name:POLLACK, WENDY R (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:POLLACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FERNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2220
Mailing Address - Country:US
Mailing Address - Phone:973-714-2771
Mailing Address - Fax:
Practice Address - Street 1:10 BROOKSIDE AVE
Practice Address - Street 2:#1B
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5600
Practice Address - Country:US
Practice Address - Phone:973-714-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052563001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11446618OtherCAQH
NJ11446618OtherCAQH