| Doctor Name: | GORDON H. HOMER |
| NPI Number: | 1205961174 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSED. |
| License Number: | 126 |
| Business Practice Address: | 309 Hudson Rd Stow, MA - 017750123 |
| Business Phone Number: | 9785681909 |
| Business Fax Number: | |
| Mailing Address: | Po Box 123, 309 Hudson Rd STOW |
| State: | MA |
| Postal Code: | 017750123 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 126 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |