Provider Demographics
NPI:1194072355
Name:POLLINO VAMOS, ANNETTE (LPC)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:POLLINO VAMOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901-1808
Mailing Address - Country:US
Mailing Address - Phone:814-254-4502
Mailing Address - Fax:814-254-4725
Practice Address - Street 1:417 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1808
Practice Address - Country:US
Practice Address - Phone:814-254-4502
Practice Address - Fax:814-254-4725
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional