Provider Demographics
NPI:1215169503
Name:HOMER, KAY FRANCES (RN, LCSW)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:FRANCES
Last Name:HOMER
Suffix:
Gender:F
Credentials:RN, LCSW
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 714
Mailing Address - Street 2:
Mailing Address - City:OCCOQUAN
Mailing Address - State:VA
Mailing Address - Zip Code:22125-0714
Mailing Address - Country:US
Mailing Address - Phone:703-494-3452
Mailing Address - Fax:
Practice Address - Street 1:ADOLESCENT PSYCHIATRIC PARTIAL HOSPITAL PROGRAM C/A MH
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5944
Practice Address - Country:US
Practice Address - Phone:703-545-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059741041C0700X
VA0001139683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse