Healthcare Provider Details

I. General information

NPI: 1235928029
Provider Name (Legal Business Name): HOMECOMING PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 NONOTUCK ST
FLORENCE MA
01062-1907
US

IV. Provider business mailing address

PO BOX 60071
FLORENCE MA
01062-0071
US

V. Phone/Fax

Practice location:
  • Phone: 617-417-1055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CJ WILD EVERHART
Title or Position: ORGANIZER
Credential: LMHC
Phone: 617-417-1055