Provider Demographics
NPI:1992795843
Name:POLLACK, RACHELE A (LCSW-R, CASAC)
Entity type:Individual
Prefix:MS
First Name:RACHELE
Middle Name:A
Last Name:POLLACK
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SARANAC WAY
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9489
Mailing Address - Country:US
Mailing Address - Phone:607-277-7363
Mailing Address - Fax:
Practice Address - Street 1:319 N TIOGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4205
Practice Address - Country:US
Practice Address - Phone:607-269-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2511101YA0400X
NY1041S0200X
NYR0288311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool