Provider Demographics
NPI:1871632562
Name:POMEROY, KATHERINE LEIGH (MA,MS,LMFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEIGH
Last Name:POMEROY
Suffix:
Gender:F
Credentials:MA,MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1814
Mailing Address - Country:US
Mailing Address - Phone:860-274-8562
Mailing Address - Fax:203-757-9357
Practice Address - Street 1:2030 STRAITS TPKE
Practice Address - Street 2:STE 2
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1831
Practice Address - Country:US
Practice Address - Phone:203-577-6444
Practice Address - Fax:203-577-6444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11346325OtherCAQH
CT11346325OtherCAQH
CT410001067CT03Medicare UPIN
CT004257326Medicare UPIN
CT410001067CT01Medicare UPIN
CT004257318Medicare ID - Type UnspecifiedHUSKY