Provider Demographics
NPI:1083046106
Name:POMA, HEATHER K (PSYD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:POMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 WINDHAM CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5034
Mailing Address - Country:US
Mailing Address - Phone:330-953-1354
Mailing Address - Fax:330-953-1364
Practice Address - Street 1:945 WINDHAM CT
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5034
Practice Address - Country:US
Practice Address - Phone:330-953-1354
Practice Address - Fax:330-953-1364
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7091103TC0700X
OHF. 1400018106H00000X
PAPS017649103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH228281OtherPTAN
OH2314561Medicaid
OH0112662Medicaid