Provider Demographics
NPI:1922297688
Name:POLLAK, ANDREW S (LMFT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:POLLAK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOME STAKE LN
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-2423
Mailing Address - Country:US
Mailing Address - Phone:860-663-3000
Mailing Address - Fax:860-663-1335
Practice Address - Street 1:99 WHITFIELD ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-3429
Practice Address - Country:US
Practice Address - Phone:203-453-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist