Provider Demographics
NPI:1578168902
Name:SIMOTAS, ELENORE ROSE
Entity Type:Individual
Prefix:
First Name:ELENORE
Middle Name:ROSE
Last Name:SIMOTAS
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 1:112 NOBLE ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2510
Mailing Address - Country:US
Mailing Address - Phone:917-403-6510
Mailing Address - Fax:
Practice Address - Street 1:300 CADMAN PLZ W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3229
Practice Address - Country:US
Practice Address - Phone:212-828-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health