Provider Demographics
NPI:1841594421
Name:SIMMERMAN, DALE (LMSW)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:SIMMERMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1138
Mailing Address - Country:US
Mailing Address - Phone:734-213-2326
Mailing Address - Fax:734-213-2326
Practice Address - Street 1:110 E KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1138
Practice Address - Country:US
Practice Address - Phone:734-213-2326
Practice Address - Fax:734-213-2326
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010675191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical