Provider Demographics
NPI:1073721247
Name:POMERANTZ, BRUCE STEVEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEVEN
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6935 WISCONSIN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6109
Mailing Address - Country:US
Mailing Address - Phone:301-654-8717
Mailing Address - Fax:301-654-1764
Practice Address - Street 1:6935 WISCONSIN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6109
Practice Address - Country:US
Practice Address - Phone:301-654-8717
Practice Address - Fax:301-654-1764
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02482103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical