Provider Demographics
NPI:1922230291
Name:HOMAN, CAROLYN MERRILL (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:MERRILL
Last Name:HOMAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-584-1100
Mailing Address - Fax:508-427-4394
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5340
Practice Address - Country:US
Practice Address - Phone:508-584-1100
Practice Address - Fax:508-427-4394
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2179391041C0700X
MA1216241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical