Provider Demographics
NPI:1508873928
Name:SIMONE, SIMONE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:J
Last Name:SIMONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10585 THREE RIVERS RD
Mailing Address - Street 2:STE C
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3572
Mailing Address - Country:US
Mailing Address - Phone:228-604-0099
Mailing Address - Fax:
Practice Address - Street 1:10585 THREE RIVERS RD STE C
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3572
Practice Address - Country:US
Practice Address - Phone:228-604-0099
Practice Address - Fax:228-604-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS35-591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118696Medicaid
MSS43333Medicare UPIN
MS00118696Medicaid