Provider Demographics
NPI:1467647123
Name:HOMEYER, CAROL M (LIC AC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:HOMEYER
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2022
Mailing Address - Country:US
Mailing Address - Phone:617-283-7600
Mailing Address - Fax:
Practice Address - Street 1:125 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2022
Practice Address - Country:US
Practice Address - Phone:617-283-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221191171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist