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General NPI Number Information
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NPI Number | 1063126514
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Entity Type | Organization
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Legal Business Name | CARLY POLLACK THERAPY P.C.
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 159 HI COUNTRY DR UNIT 7
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City | WINTER PARK
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State | CO
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Zip | 80482-5385
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Country | US
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Telephone | 810-599-2727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 635
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City | WINTER PARK
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State | CO
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Zip | 80482-0635
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Country | US
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Telephone | 810-599-2727
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARLY POLLACK
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Credential | LCSW (#113909)
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Telephone | 810-599-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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