Provider Demographics
NPI:1922545649
Name:THE MARTIN POLLAK PROJECT INC.
Entity Type:Organization
Organization Name:THE MARTIN POLLAK PROJECT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-685-2525
Mailing Address - Street 1:3701 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4208
Mailing Address - Country:US
Mailing Address - Phone:410-685-2525
Mailing Address - Fax:410-617-8243
Practice Address - Street 1:3701 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4208
Practice Address - Country:US
Practice Address - Phone:410-685-2525
Practice Address - Fax:410-617-8243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN POLLAK PROJECT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-2180261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH002229Medicaid