Provider Demographics
NPI:1619170479
Name:SIMAS, PHYLLIS B (INTERN)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:B
Last Name:SIMAS
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 IRETA RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-1714
Mailing Address - Country:US
Mailing Address - Phone:508-845-1462
Mailing Address - Fax:
Practice Address - Street 1:240 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-1714
Practice Address - Country:US
Practice Address - Phone:508-984-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1245317205Medicare UPIN