Provider Demographics
NPI:1568935062
Name:MILLS, SIMONE A
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:A
Last Name:MILLS
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 1:8336 BEVERLY RD APT 6C
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1720
Mailing Address - Country:US
Mailing Address - Phone:646-379-7459
Mailing Address - Fax:
Practice Address - Street 1:8336 BEVERLY RD APT 6C
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1720
Practice Address - Country:US
Practice Address - Phone:646-379-7459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100511104100000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No104100000XBehavioral Health & Social Service ProvidersSocial Worker