Provider Demographics
NPI:1407440704
Name:OVALLE, SIMTHIA C
Entity Type:Individual
Prefix:
First Name:SIMTHIA
Middle Name:C
Last Name:OVALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WESTCHESTER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4500
Mailing Address - Country:US
Mailing Address - Phone:347-621-2185
Mailing Address - Fax:
Practice Address - Street 1:2055 MCGRAW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-8014
Practice Address - Country:US
Practice Address - Phone:917-703-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst