Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301006738 | MI |
N | 103G00000X | Clinical Psychologist | 6301006738 | MI |
N | 103TC0700X | Clinical Psychologist | 6301006738 | MI |
NPI | 1003993635 |
---|---|
Provider Name | Ovide F Pomerleau |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-0118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |