Healthcare Provider Details

I. General information

NPI: 1821087602
Provider Name (Legal Business Name): RICHARD EDWARD POLLOCK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARIS ST
NORWAY ME
04268-5654
US

IV. Provider business mailing address

PO BOX 104
SOUTH PARIS ME
04281-0104
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-7833
  • Fax:
Mailing address:
  • Phone: 207-583-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC1771
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: