Provider Demographics
NPI:1154665792
Name:CHRISTINE M. HOMEN MSW,LICSW
Entity Type:Organization
Organization Name:CHRISTINE M. HOMEN MSW,LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LICSW
Authorized Official - Phone:508-813-0317
Mailing Address - Street 1:10 THACHER BROOK CIR APT 5
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5140
Mailing Address - Country:US
Mailing Address - Phone:508-813-0317
Mailing Address - Fax:401-353-2912
Practice Address - Street 1:32 WELBY ROAD
Practice Address - Street 2:SUITE 114B
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745
Practice Address - Country:US
Practice Address - Phone:508-813-0317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1030845251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health