Provider Demographics
NPI:1750467726
Name:HOMAN, KRISTEN M (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:M
Last Name:HOMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FRONT ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3744
Mailing Address - Country:US
Mailing Address - Phone:978-219-4713
Mailing Address - Fax:
Practice Address - Street 1:8 FRONT ST
Practice Address - Street 2:SUITE 216
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3744
Practice Address - Country:US
Practice Address - Phone:978-219-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111731104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker