Provider Demographics
NPI:1679971519
Name:POMEROY, MARION
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:POMEROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01262-0883
Mailing Address - Country:US
Mailing Address - Phone:518-265-7458
Mailing Address - Fax:
Practice Address - Street 1:13 MAIN ST
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01262
Practice Address - Country:US
Practice Address - Phone:518-265-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1210811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical