Provider Demographics
NPI:1831459650
Name:DE SIMONE, GINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:DE SIMONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 N 16TH ST
Mailing Address - Street 2:SUITE C200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5237
Mailing Address - Country:US
Mailing Address - Phone:602-795-1670
Mailing Address - Fax:
Practice Address - Street 1:7330 N 16TH ST
Practice Address - Street 2:SUITE C200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5237
Practice Address - Country:US
Practice Address - Phone:602-795-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-26
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3991103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent