Provider Demographics
NPI:1841622263
Name:SIMONIELLO, ALICE MARY
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:MARY
Last Name:SIMONIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALICE
Other - Middle Name:MARY
Other - Last Name:MCKEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2409
Mailing Address - Country:US
Mailing Address - Phone:860-635-6010
Mailing Address - Fax:860-635-3425
Practice Address - Street 1:60 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2409
Practice Address - Country:US
Practice Address - Phone:860-635-6010
Practice Address - Fax:860-635-3425
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0038691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003869OtherLISENCED CLINICAL SOCIAL WORKER