Provider Demographics
NPI:1740375948
Name:COLLYMORE, SIMONE F M (PHD)
Entity type:Individual
Prefix:DR
First Name:SIMONE
Middle Name:F M
Last Name:COLLYMORE
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:212 FAIR ST
Mailing Address - Street 2:PO BOX 3065
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-3065
Mailing Address - Country:US
Mailing Address - Phone:845-338-4784
Mailing Address - Fax:845-454-1441
Practice Address - Street 1:212 FAIR STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-338-4784
Practice Address - Fax:845-454-1441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY013677103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVE2681Medicare PIN