MEDICARE: DR. JUDY POMERANTZ PSY D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2046	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003927955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY POMERANTZ PSY D

Provider Business Mailing Address
First Line	:	4100 E MISSISSIPPI AVE
Second Line	:	SUITE 600
City	:	GLENDALE
State	:	CO
Zip	:	80246-3048
Country	:	US
Telephone Number	:	303-759-3098
Fax Number	:	303-759-3515

Provider Business Practice Location Address
First Line	:	4100 E MISSISSIPPI AVE
Second Line	:	SUITE 600
City	:	GLENDALE
State	:	CO
Zip	:	80246-3048
Country	:	US
Telephone Number	:	303-759-3098
Fax Number	:	303-759-3515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/10/2010

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