Provider Demographics
NPI:1760157457
Name:JONATHAN SIMMONS PLLC
Entity Type:Organization
Organization Name:JONATHAN SIMMONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-386-8508
Mailing Address - Street 1:4 OLD FORGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-3016
Mailing Address - Country:US
Mailing Address - Phone:508-386-8508
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:15 DEPOT AVE
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2301
Practice Address - Country:US
Practice Address - Phone:508-386-8508
Practice Address - Fax:508-433-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty