Provider Demographics
NPI:1346845484
Name:SIMMONS, RUBY A (MFT)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:A
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4484 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-4809
Mailing Address - Country:US
Mailing Address - Phone:612-735-6931
Mailing Address - Fax:
Practice Address - Street 1:4484 FLEMING ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-4809
Practice Address - Country:US
Practice Address - Phone:612-735-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty