Provider Demographics
NPI:1336749050
Name:POLLOCK, JADA LECHAN
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:LECHAN
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1204
Mailing Address - Country:US
Mailing Address - Phone:516-462-6395
Mailing Address - Fax:
Practice Address - Street 1:213 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1656
Practice Address - Country:US
Practice Address - Phone:516-246-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health