Provider Demographics
NPI:1902122948
Name:POLLACK, KRISTAL MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:MARIE
Last Name:POLLACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 NAVAREZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-2106
Mailing Address - Country:US
Mailing Address - Phone:813-951-7346
Mailing Address - Fax:
Practice Address - Street 1:101 AMERICAN CENTER PL
Practice Address - Street 2:SUITE 108
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4448
Practice Address - Country:US
Practice Address - Phone:813-951-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW98441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical