Provider Demographics
NPI:1013101864
Name:POMERANTZ, DIANE CARLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:CARLA
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 1:4 POINSETTIA CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1109
Mailing Address - Country:US
Mailing Address - Phone:410-653-9079
Mailing Address - Fax:
Practice Address - Street 1:660 KENILWORTH DR STE 101
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2353
Practice Address - Country:US
Practice Address - Phone:410-653-9079
Practice Address - Fax:410-887-5384
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01580103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist