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General NPI Number Information
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NPI Number | 1912428855
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Entity Type | Individual
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Provider Name | GLENN L POLLACK PSY.D
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Gender | Male
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 29 BARSTOW RD
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City | GREAT NECK
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State | NY
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Zip | 11021-2222
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Country | US
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Telephone | 914-522-1889
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Fax |
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Provider Business Mailing Address
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Address Line | 14 CHERRY LN
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City | SCARSDALE
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State | NY
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Zip | 10583-3118
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Country | US
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Telephone | 914-522-1889
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 009228
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License Number State | NY
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