Provider Demographics
NPI:1053497206
Name:SIMONE, RENEE (APRN, LICSW, LADC I)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:APRN, LICSW, LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MARY ST STE 1802
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1139
Mailing Address - Country:US
Mailing Address - Phone:919-793-6862
Mailing Address - Fax:413-315-8068
Practice Address - Street 1:71 MARY ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1139
Practice Address - Country:US
Practice Address - Phone:413-536-1918
Practice Address - Fax:413-536-8078
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1181101YA0400X
MA1117951041C0700X
MAMS1125839N363LP2300X
CT7234363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2197528OtherCIGNA
MA1036490OtherNHP
MA861096515OtherAETNA
MAP08297OtherBC/BS
CT1053497206Medicaid
MA1853171Medicaid
MA726247000OtherMAGELLAN
CT1053497206Medicaid
MA1853171Medicaid