Provider Demographics
NPI:1790878395
Name:SIMPSON, MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 WESTON ROAD
Mailing Address - Street 2:STE 305
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-217-3966
Mailing Address - Fax:800-921-4580
Practice Address - Street 1:1040 WESTON ROAD
Practice Address - Street 2:STE 305
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-217-3966
Practice Address - Fax:800-921-4580
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1960ZMedicare ID - Type UnspecifiedPROVIDER NUMBER