Provider Demographics
NPI:1598044620
Name:CROMWELL, SIMONE ELISABETH (MA, LMFTTC)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:ELISABETH
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:MA, LMFTTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:EAST BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04629-0092
Mailing Address - Country:US
Mailing Address - Phone:207-374-2137
Mailing Address - Fax:
Practice Address - Street 1:360 HARLOW ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4908
Practice Address - Country:US
Practice Address - Phone:877-668-8678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METXM3837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist