Provider Demographics
NPI:1679975031
Name:SIMON, EMILY VANESSA
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:VANESSA
Last Name:SIMON
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 1:13 BEACON HILL AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3702
Mailing Address - Country:US
Mailing Address - Phone:781-913-2121
Mailing Address - Fax:
Practice Address - Street 1:13 BEACON HILL AVE
Practice Address - Street 2:APT 2
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3702
Practice Address - Country:US
Practice Address - Phone:781-913-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100001899333OtherMASS HEALTH, BMC