Provider Demographics
NPI:1033215066
Name:SIMMONS, ROBERT JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3024
Mailing Address - Country:US
Mailing Address - Phone:978-537-0878
Mailing Address - Fax:
Practice Address - Street 1:26 VISTA AVE
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3024
Practice Address - Country:US
Practice Address - Phone:978-537-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA44040OtherCIGNA HEALTH CARE
MA195289OtherMANAGED HEALTH NETWORK
MAS11015OtherCHAMPUS (UPIN)
MAVALUE OPTIONSOther009345
MA716849OtherTUFTS HEALTH PLAN
MASI W01311OtherBLUECROSS/BLUESHIELDOF MA
MA1651000OtherCIGNA HEALTH CARE
MA195289OtherMANAGED HEALTH NETWORK