Provider Demographics
NPI:1235723651
Name:SMITH, SIMONE (MHC-LP)
Entity Type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 FRANKLIN TPKE APT 14
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2215
Mailing Address - Country:US
Mailing Address - Phone:914-906-0213
Mailing Address - Fax:
Practice Address - Street 1:3033 GODWIN TER
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5342
Practice Address - Country:US
Practice Address - Phone:347-615-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health