Provider Demographics
NPI:1295202620
Name:SIMMONS, ALPHONSO (MSW)
Entity Type:Individual
Prefix:
First Name:ALPHONSO
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 3RD AVE APT 2306
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2239
Mailing Address - Country:US
Mailing Address - Phone:646-228-2383
Mailing Address - Fax:
Practice Address - Street 1:20 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3713
Practice Address - Country:US
Practice Address - Phone:914-964-6767
Practice Address - Fax:914-964-8282
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32838101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)