Provider Demographics
NPI:1326151879
Name:SIMONE, MONIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-6022
Mailing Address - Country:US
Mailing Address - Phone:207-490-4520
Mailing Address - Fax:207-490-4521
Practice Address - Street 1:263 SUNSET RD
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-6022
Practice Address - Country:US
Practice Address - Phone:207-490-4520
Practice Address - Fax:207-490-4521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME5222161041C0700X
MELC108461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME2429OtherMEDICARE
ME431635699Medicaid