Provider Demographics
NPI:1821035403
Name:LEJEUNE, SIMON M. W. (MD)
Entity Type:Individual
Prefix:
First Name:SIMON M. W.
Middle Name:
Last Name:LEJEUNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BEALS ST
Mailing Address - Street 2:APT. #2
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6011
Mailing Address - Country:US
Mailing Address - Phone:617-253-2916
Mailing Address - Fax:
Practice Address - Street 1:77 MASS AVE E23
Practice Address - Street 2:MIT MEDICAL CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-253-2916
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA566872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry