Provider Demographics
NPI:1821587676
Name:SIMMS, JENNIFER NICHOLLE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICHOLLE
Last Name:SIMMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WOLFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25097 OLYMPIA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3912
Mailing Address - Country:US
Mailing Address - Phone:941-347-8341
Mailing Address - Fax:941-347-7702
Practice Address - Street 1:25097 OLYMPIA AVE STE 205
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3912
Practice Address - Country:US
Practice Address - Phone:941-347-8341
Practice Address - Fax:941-347-7702
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW152441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical