Provider Demographics
NPI:1568955128
Name:POMNITZ, LARA (LMSW, BSW)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:POMNITZ
Suffix:
Gender:F
Credentials:LMSW, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34617 NANCY ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4394
Mailing Address - Country:US
Mailing Address - Phone:248-599-2213
Mailing Address - Fax:
Practice Address - Street 1:34617 NANCY ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4394
Practice Address - Country:US
Practice Address - Phone:248-599-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801105888104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker