Provider Demographics
NPI:1093284648
Name:HOMAN, OLIVIA JUDITH
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JUDITH
Last Name:HOMAN
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 1:210 PARK AVE # 359
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2246
Mailing Address - Country:US
Mailing Address - Phone:617-581-2267
Mailing Address - Fax:
Practice Address - Street 1:9 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2586
Practice Address - Country:US
Practice Address - Phone:617-581-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1237201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical