Provider Demographics
NPI:1063503563
Name:SIMMONS, KATHERINE M (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:302 COMMERCIAL ST
Mailing Address - Street 2:#12
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3552
Mailing Address - Country:US
Mailing Address - Phone:781-848-1977
Mailing Address - Fax:
Practice Address - Street 1:45 EASTMAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1279
Practice Address - Country:US
Practice Address - Phone:508-238-5766
Practice Address - Fax:508-238-8045
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1176OtherBLUE COSS BLUE SHIELD