MEDICARE: MRS. REBECCA LOU POMEROY L.P.C.

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	101YP2500X	Professional Counselor	PC000290	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	472485	OTHER	PA	VALUE OPTIONS

General Provider Information

NPI Number	:	1487626024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA LOU POMEROY L.P.C.

Provider Business Mailing Address
First Line	:	1520 TOWNHALL RD W
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16509-5052
Country	:	US
Telephone Number	:	814-864-2042
Fax Number	:

Provider Business Practice Location Address
First Line	:	1371 W 6TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-2503
Country	:	US
Telephone Number	:	814-456-6770
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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