Provider Demographics
NPI:1043986771
Name:SIMEN, AMBAR DEJESUS
Entity Type:Individual
Prefix:
First Name:AMBAR
Middle Name:DEJESUS
Last Name:SIMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 HADLEY WEST DR APT 203
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-3638
Mailing Address - Country:US
Mailing Address - Phone:978-914-1266
Mailing Address - Fax:
Practice Address - Street 1:514 HADLEY WEST DR APT 203
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-3638
Practice Address - Country:US
Practice Address - Phone:978-914-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician