Provider Demographics
NPI:1306541081
Name:POLLOCK, ADAM E (MA, LP)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:E
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HANOVER SQ STE 27D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2818
Mailing Address - Country:US
Mailing Address - Phone:646-391-4453
Mailing Address - Fax:
Practice Address - Street 1:11 HANOVER SQ STE 27D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2818
Practice Address - Country:US
Practice Address - Phone:646-391-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001172-01102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst