Healthcare Provider Details

I. General information

NPI: 1043141674
Provider Name (Legal Business Name): EVENSTAR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 VICTORIA AVE
WORCESTER MA
01607-1506
US

IV. Provider business mailing address

14 VICTORIA AVE
WORCESTER MA
01607-1506
US

V. Phone/Fax

Practice location:
  • Phone: 508-233-8586
  • Fax: 774-366-0757
Mailing address:
  • Phone: 508-233-8586
  • Fax: 774-366-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH O'CALLAHAN
Title or Position: OWNER/PROVIDER
Credential: MA, LMHC, BCBA, LABA
Phone: 508-233-8586