Healthcare Provider Details

I. General information

NPI: 1073107520
Provider Name (Legal Business Name): CARLY POLLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 05/09/2023
Certification Date: 04/24/2023
Deactivation Date: 03/03/2023
Reactivation Date: 04/24/2023

III. Provider practice location address

390 40TH ST
OAKLAND CA
94609-2633
US

IV. Provider business mailing address

1024 LINDEN ST
OAKLAND CA
94607-2728
US

V. Phone/Fax

Practice location:
  • Phone: 510-613-0330
  • Fax:
Mailing address:
  • Phone: 810-599-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: