Provider Demographics
NPI:1255890505
Name:POLLARD, KAY CAROL (CLINICAL SW)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:CAROL
Last Name:POLLARD
Suffix:
Gender:F
Credentials:CLINICAL SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 5TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2609
Mailing Address - Country:US
Mailing Address - Phone:570-424-5100
Mailing Address - Fax:
Practice Address - Street 1:1300 N 5TH ST STE 102
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2609
Practice Address - Country:US
Practice Address - Phone:570-424-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0202191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical