Provider Demographics
NPI:1982668083
Name:SIMONDS, CHANDRA (LICSW)
Entity Type:Individual
Prefix:
First Name:CHANDRA
Middle Name:
Last Name:SIMONDS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PRINCETON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1558
Mailing Address - Country:US
Mailing Address - Phone:978-256-6579
Mailing Address - Fax:978-256-1943
Practice Address - Street 1:73 PRINCETON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1558
Practice Address - Country:US
Practice Address - Phone:978-256-6579
Practice Address - Fax:978-256-1943
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176530101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPHCSOther9413895
MATUFTSOther494537
MANETWORKOther96618201
MAP23987Medicare ID - Type Unspecified