Provider Demographics
NPI:1841223898
Name:POMROY, CONCETTA TINA A (MA)
Entity Type:Individual
Prefix:MS
First Name:CONCETTA TINA
Middle Name:A
Last Name:POMROY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 S CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6000
Mailing Address - Country:US
Mailing Address - Phone:386-767-7252
Mailing Address - Fax:386-898-0534
Practice Address - Street 1:4643 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6000
Practice Address - Country:US
Practice Address - Phone:386-767-7252
Practice Address - Fax:386-898-0534
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health