Provider Demographics
NPI:1437586732
Name:SIMONCELLI, JOHN WEDGE (LCSW, LADC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WEDGE
Last Name:SIMONCELLI
Suffix:
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-2001
Mailing Address - Country:US
Mailing Address - Phone:860-805-2267
Mailing Address - Fax:
Practice Address - Street 1:37 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CT
Practice Address - Zip Code:06759-2001
Practice Address - Country:US
Practice Address - Phone:860-805-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1058101YA0400X
CT0097531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)