Provider Demographics
NPI:1669753653
Name:POMALES ROSA, CHEMELY PAOLA (PSYD)
Entity type:Individual
Prefix:
First Name:CHEMELY
Middle Name:PAOLA
Last Name:POMALES ROSA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CHEMELY
Other - Middle Name:PAOLA
Other - Last Name:POMALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:938 W NELSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6704
Mailing Address - Country:US
Mailing Address - Phone:773-296-3220
Mailing Address - Fax:773-296-3226
Practice Address - Street 1:938 W NELSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-296-3220
Practice Address - Fax:773-296-3226
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical