Provider Demographics
NPI:1598969446
Name:POMEROY, MOLLY MARIE (MS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:POMEROY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4137
Mailing Address - Country:US
Mailing Address - Phone:816-699-9920
Mailing Address - Fax:816-366-0077
Practice Address - Street 1:607 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4137
Practice Address - Country:US
Practice Address - Phone:816-699-9920
Practice Address - Fax:816-366-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst