Provider Demographics
NPI:1811064553
Name:POMERANTZ, BARRY (LICSW)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:POMERANTZ
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OAK TER
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1409
Mailing Address - Country:US
Mailing Address - Phone:617-964-6497
Mailing Address - Fax:
Practice Address - Street 1:34 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1507
Practice Address - Country:US
Practice Address - Phone:617-964-1060
Practice Address - Fax:617-630-0381
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA951101YA0400X
MA1009741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01087OtherBLUE CROSS BLUE SHIELD