Healthcare Provider Details

I. General information

NPI: 1942298724
Provider Name (Legal Business Name): RANDY SUSAN POLLARD LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE SUITE 137
ROCKVILLE CENTRE NY
11570-3761
US

IV. Provider business mailing address

165 N VILLAGE AVE STE 137
ROCKVILLE CENTRE NY
11570-3701
US

V. Phone/Fax

Practice location:
  • Phone: 516-766-0998
  • Fax:
Mailing address:
  • Phone: 516-766-0998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR049154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: