Provider Demographics
NPI:1184615643
Name:POLLAK, LAUREN ELYSE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELYSE
Last Name:POLLAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:5 EMERSON PL
Practice Address - Street 2:PSYCHOLOGY ASSESSMENT CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2240
Practice Address - Country:US
Practice Address - Phone:617-726-2623
Practice Address - Fax:617-724-3726
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7648103T00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06052OtherBCBS MA
MA410587OtherTUFTS HEALTH PLAN
MA0596124Medicaid
MA410587OtherTUFTS HEALTH PLAN