Provider Demographics
NPI:1083863666
Name:POMEROY, ROXANNE KIEDA (JD, MA)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:KIEDA
Last Name:POMEROY
Suffix:
Gender:F
Credentials:JD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1865
Mailing Address - Country:US
Mailing Address - Phone:860-573-8602
Mailing Address - Fax:
Practice Address - Street 1:945 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-1865
Practice Address - Country:US
Practice Address - Phone:860-573-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist