Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2064 | CO |
N | 103TC0700X | Clinical Psychologist | 2064 | CO |
N | 103G00000X | Clinical Psychologist | 2064 | CO |
N | 103TC0700X | Clinical Psychologist | 2064 | CO |
N | 103TR0400X | Rehabilitation Psychologist | 2064 | CO |
NPI | 1316090483 |
---|---|
Provider Name | Dr. Jacob Marc Pomerantz |
First Address | Westminster, CO 80031-6956 |
Second Address | Westminster, CO 80031-6956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04142246 | (05) | CO |
07020647 | (05) | CO |
S19580 | (02) | CO |