Healthcare Provider Details

I. General information

NPI: 1043509870
Provider Name (Legal Business Name): LAUREN ALEXIS POLLARD LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 180TH ST
JAMAICA NY
11434-4108
US

IV. Provider business mailing address

61 GLENGARIFF RD
MASSAPEQUA PARK NY
11762-3022
US

V. Phone/Fax

Practice location:
  • Phone: 718-527-2200
  • Fax: 718-527-3707
Mailing address:
  • Phone: 516-633-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number079568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: