Provider Demographics
NPI:1063126514
Name:CARLY POLLACK THERAPY P.C.
Entity type:Organization
Organization Name:CARLY POLLACK THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW (#113909)
Authorized Official - Phone:810-599-2727
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80482-0635
Mailing Address - Country:US
Mailing Address - Phone:810-599-2727
Mailing Address - Fax:
Practice Address - Street 1:159 HI COUNTRY DR UNIT 7
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482-5385
Practice Address - Country:US
Practice Address - Phone:810-599-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty