Provider Demographics
NPI:1518604255
Name:PERRY, SIMONE NICHOLE (EDM)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:NICHOLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10532 FLATLANDS 1ST ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3008
Mailing Address - Country:US
Mailing Address - Phone:732-737-1615
Mailing Address - Fax:
Practice Address - Street 1:6714 41ST AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-8128
Practice Address - Country:US
Practice Address - Phone:718-651-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-15
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102X00000XBehavioral Health & Social Service ProvidersPoetry TherapistGroup - Multi-Specialty