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General NPI Number Information
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NPI Number | 1215149901
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Entity Type | Individual
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Provider Name | BRUCE MATTHEW POLLACK LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 475 PARK AVENUE SOUTH 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 646-459-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 30 BRADLEY AVENUE
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City | WHITE PLAINS
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State | NY
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Zip | 10607
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Country | US
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Telephone | 917-957-5673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 069504
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License Number State | NY
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