Provider Demographics
NPI:1083779318
Name:SIMENELLI, KIMBERLEE ANN (MS CERTIFIED EARLY I)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:ANN
Last Name:SIMENELLI
Suffix:
Gender:F
Credentials:MS CERTIFIED EARLY I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4B SEAGIRT AVE
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906
Mailing Address - Country:US
Mailing Address - Phone:617-240-2569
Mailing Address - Fax:
Practice Address - Street 1:148 WARREN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-452-1736
Practice Address - Fax:978-452-6625
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1217390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program