Provider Demographics
NPI:1669091898
Name:HOMER, ELIZA S (PHD, LCPC, ATR-BC)
Entity type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:S
Last Name:HOMER
Suffix:
Gender:F
Credentials:PHD, LCPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-0804
Mailing Address - Country:US
Mailing Address - Phone:509-679-6799
Mailing Address - Fax:207-333-3037
Practice Address - Street 1:43 DRIFTWOOD WAY
Practice Address - Street 2:
Practice Address - City:MOUNT DESERT
Practice Address - State:ME
Practice Address - Zip Code:04660
Practice Address - Country:US
Practice Address - Phone:509-679-6799
Practice Address - Fax:207-333-3037
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13820101YM0800X
MEXL5350101YM0800X
MECC6758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health