Provider Demographics
NPI:1770635567
Name:SIMMONS, BARBARA L (SW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 ISLETA BLVD SW
Mailing Address - Street 2:HARRISON MS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-6131
Mailing Address - Country:US
Mailing Address - Phone:505-877-1279
Mailing Address - Fax:
Practice Address - Street 1:3912 ISLETA BLVD SW
Practice Address - Street 2:HARRISON MS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6131
Practice Address - Country:US
Practice Address - Phone:505-877-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 38851041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool