Healthcare Provider Details

I. General information

NPI: 1811571862
Provider Name (Legal Business Name): NICOLE C. POLLACK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RESERVOIR ST STE 28
NEEDHAM MA
02494-3133
US

IV. Provider business mailing address

220 RESERVOIR ST STE 28
NEEDHAM HEIGHTS MA
02494-3133
US

V. Phone/Fax

Practice location:
  • Phone: 781-429-7755
  • Fax:
Mailing address:
  • Phone: 617-901-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1142028
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: