Provider Demographics
NPI:1942927892
Name:SIMMONS, LILLIAN CONSUELO
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:CONSUELO
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PIER POINTE ST APT 103F
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6942
Mailing Address - Country:US
Mailing Address - Phone:646-671-1382
Mailing Address - Fax:
Practice Address - Street 1:1 PIER POINTE ST APT 103F
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6942
Practice Address - Country:US
Practice Address - Phone:646-671-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker