Provider Demographics
NPI:1043513617
Name:JUDY POMERANTZ, PSY.D., P.C.
Entity type:Organization
Organization Name:JUDY POMERANTZ, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:POMERANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-759-3098
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87020464Medicaid
CO87020464Medicaid