Provider Demographics
NPI:1518308766
Name:SIMONEAU, MARION MERRICK (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:MERRICK
Last Name:SIMONEAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:MARION
Other - Middle Name:WOODWARD
Other - Last Name:MERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:251 HEATH ST
Mailing Address - Street 2:UNIT 211
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-1171
Mailing Address - Country:US
Mailing Address - Phone:978-430-2405
Mailing Address - Fax:
Practice Address - Street 1:251 HEATH ST
Practice Address - Street 2:UNIT 211
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1171
Practice Address - Country:US
Practice Address - Phone:978-430-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA116558104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker