Provider Demographics
NPI:1649027095
Name:POLLINO, RICHARD RYAN KENNETH
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:RYAN KENNETH
Last Name:POLLINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4710
Mailing Address - Country:US
Mailing Address - Phone:716-640-8576
Mailing Address - Fax:
Practice Address - Street 1:141 CATLIN AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4710
Practice Address - Country:US
Practice Address - Phone:716-640-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP127816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health