Healthcare Provider Details

I. General information

NPI: 1972431195
Provider Name (Legal Business Name): EVENSTAR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
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: 508-410-4414
  • Fax:
Mailing address:
  • Phone: 508-410-4414
  • Fax:

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 ANN O'CALLAHAN
Title or Position: PROVIDER/OWNER
Credential: MA, LMHC, BCBA, LABA
Phone: 508-410-4414