1437235819 NPI number — LYNDA N. SIMMONS LICSW

Table of content: (NPI 1346598810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437235819 NPI number — LYNDA N. SIMMONS LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMMONS
Provider First Name:
LYNDA
Provider Middle Name:
N.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437235819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 VISTA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453-3024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-537-0878
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 VISTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-3024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-537-0878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  104794 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 193835 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 101540 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 711150 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: SI P03162 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 009344 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1411800 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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