Provider Demographics
NPI:1104115336
Name:POMETTO, EUGENE ANTHONY JR (LCPC, NBCCH)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:ANTHONY
Last Name:POMETTO
Suffix:JR
Gender:M
Credentials:LCPC, NBCCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 GUN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3822
Mailing Address - Country:US
Mailing Address - Phone:410-925-2241
Mailing Address - Fax:410-242-4848
Practice Address - Street 1:2324 W JOPPA RD STE 410
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4620
Practice Address - Country:US
Practice Address - Phone:443-446-4718
Practice Address - Fax:347-391-0191
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health