Provider Demographics
NPI:1760744239
Name:SIMMS-ELIAS, PATRICE MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:MARIE
Last Name:SIMMS-ELIAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PARK AVE E
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3266
Mailing Address - Country:US
Mailing Address - Phone:516-652-0002
Mailing Address - Fax:
Practice Address - Street 1:52 PARK AVE E
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3266
Practice Address - Country:US
Practice Address - Phone:516-652-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist