Provider Demographics
NPI:1932318003
Name:POMERANTZ, MYRA (PHD)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:POMERANTZ
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 1:10444 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6959
Mailing Address - Country:US
Mailing Address - Phone:310-277-1020
Mailing Address - Fax:310-277-8903
Practice Address - Street 1:10444 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6959
Practice Address - Country:US
Practice Address - Phone:310-277-1020
Practice Address - Fax:310-277-8903
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical