Provider Demographics
NPI:1578827473
Name:POLLACI, KEITH W (CAP)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:W
Last Name:POLLACI
Suffix:
Gender:M
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5664 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5677
Mailing Address - Country:US
Mailing Address - Phone:352-291-5555
Mailing Address - Fax:352-291-9536
Practice Address - Street 1:5664 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5677
Practice Address - Country:US
Practice Address - Phone:352-291-5555
Practice Address - Fax:352-291-9536
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP4981101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)