Provider Demographics
NPI:1801501762
Name:SIMAO, LEANNA PATRICIA
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:PATRICIA
Last Name:SIMAO
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 1:1037 CALEF HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03825-7241
Mailing Address - Country:US
Mailing Address - Phone:603-359-0549
Mailing Address - Fax:
Practice Address - Street 1:1037 CALEF HWY STE 209
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-7241
Practice Address - Country:US
Practice Address - Phone:603-359-0549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-22-62561103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst