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NPI Code Detail

MEDICARE: DR. ADAM DAVID POLLACK PSY.D.

MEDICARE: DR. ADAM DAVID POLLACK PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY 18422CA

General Provider Information

NPI Number : 1689735854
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADAM DAVID POLLACK PSY.D.
Provider Business Mailing Address
First Line : 1305 TOMMYDON ST
Second Line : ATTN: MENTAL HEALTH DEPT.
City : STOCKTON
State : CA
Zip : 95210-3364
Country : US
Telephone Number : 209-476-5510
Fax Number :
Provider Business Practice Location Address
First Line : 1305 TOMMYDON ST
Second Line : KAISER PERMANENTE, DEPT. OF MENTAL HEALTH
City : STOCKTON
State : CA
Zip : 95210-3364
Country : US
Telephone Number : 209-476-5510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 12/30/2021

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