Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 017784 | NY |
NPI | 1003023516 |
---|---|
Provider Name | Vivian Lynn Pollock |
First Address | East Meadow, NY 11554-1859 |
Second Address | East Meadow, NY 11554-1859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017784 | NY STATE LICENSE NUMBER (01) | NY |