Provider Demographics
NPI:1912025339
Name:POLLAK, MYRA J (LPCC LICDC LSW)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:J
Last Name:POLLAK
Suffix:
Gender:F
Credentials:LPCC LICDC LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14429 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-291-3311
Mailing Address - Fax:216-291-4822
Practice Address - Street 1:14429 CEDAR RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-291-3311
Practice Address - Fax:216-291-4822
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001945103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist