Provider Demographics
NPI:1689152076
Name:SIMONE, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SIMONE
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 1:89 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2716
Mailing Address - Country:US
Mailing Address - Phone:617-519-0051
Mailing Address - Fax:
Practice Address - Street 1:360 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5525
Practice Address - Country:US
Practice Address - Phone:617-876-0369
Practice Address - Fax:617-876-6432
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120898104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA120898OtherBOARD OF REGISTRATION OF SOCIAL WORKERS