Provider Demographics
NPI:1245026103
Name:MESA, SIMONE HUNTER
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:HUNTER
Last Name:MESA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-5001
Mailing Address - Country:US
Mailing Address - Phone:860-966-6708
Mailing Address - Fax:860-966-6708
Practice Address - Street 1:37 ANDREW DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-5001
Practice Address - Country:US
Practice Address - Phone:860-966-6708
Practice Address - Fax:860-966-6708
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician