Provider Demographics
NPI:1346728920
Name:SIMMONS, JAMAAL (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:JAMAAL
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2728
Mailing Address - Country:US
Mailing Address - Phone:301-447-0905
Mailing Address - Fax:
Practice Address - Street 1:844 LOCUST RD
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2728
Practice Address - Country:US
Practice Address - Phone:301-447-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23957104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker