Provider Demographics
NPI:1043375736
Name:POLLOCK, RONALD (LCSW)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5402
Mailing Address - Country:US
Mailing Address - Phone:631-360-1414
Mailing Address - Fax:631-360-1414
Practice Address - Street 1:5 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5402
Practice Address - Country:US
Practice Address - Phone:631-360-1414
Practice Address - Fax:631-360-1414
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018448-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA129875OtherVALUE OPTIONS NATIONAL #
NY075649OtherVALUE OPTIONS
NY0075398OtherGHI ID #
NYA129875OtherVALUE OPTIONS NATIONAL #