Provider Demographics
NPI:1407043029
Name:POMERANTZ HERZBRUN, BETH LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:LYNNE
Last Name:POMERANTZ HERZBRUN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7393 NW 18TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1007
Mailing Address - Country:US
Mailing Address - Phone:954-854-5881
Mailing Address - Fax:
Practice Address - Street 1:4800 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-4722
Practice Address - Country:US
Practice Address - Phone:954-854-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54104BMedicare UPIN
54104ZMedicare UPIN
FL54104BMedicare PIN