MEDICARE: JEREMY POLLET LCSW

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
1	1041C0700X	Clinical Social Worker		NY

General Provider Information

NPI Number	:	1972984250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY POLLET LCSW

Provider Business Mailing Address
First Line	:	163 OCEAN AVE APT E3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-4750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 COURT ST STE 502
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1105
Country	:	US
Telephone Number	:	929-264-7410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	08/19/2019

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