Provider Demographics
NPI:1003927955
Name:POMERANTZ, JUDY (PSY D)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:POMERANTZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:POMERANTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4100 E MISSISSIPPI AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3048
Mailing Address - Country:US
Mailing Address - Phone:303-759-3098
Mailing Address - Fax:303-759-3515
Practice Address - Street 1:4100 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3048
Practice Address - Country:US
Practice Address - Phone:303-759-3098
Practice Address - Fax:303-759-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2046103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87020464Medicaid
CO87020464Medicaid